PRACTICAL 


THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 

GIFT  OF 

SAN  FRANCISCO 
COUNTY  MEDICAL  SOCIETY 


PRACTICAL 
ORGANOTHERAPY 


PRACTICAL 
ORGANOTHERAPY 

THE  INTERNAL  SECRETIONS 
IN  GENERAL  PRACTICE 


BY 

HENRY  R.  NARROWER,  M.  D.,  F.  R.  S.  M.  (Lond.) 


1922 
THE  HARROWER  LABORATORY 

GLENDALE,  CALIFORNIA 


'THIS  DRAWING  illustrates  the  recently  completed  Ad- 
ministration Building  of  The  Harrower  Laboratory. 
It  houses  the  general  offices,  research  laboratories,  library 
and  translations  bureau.  The  manufacturing  departments 
are  in  buildings  not  seen  in  this  view. 

Physicians  visiting  in  Southern  California  are  invited  to 
come  out  to  Glendale — the  fastest  growing  residence  city 
(for  its  size)  in  the  country — eight  miles  north  of  Los 
Los  Angeles,  and  see  what  we  are  doing. 


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Copyright  1922  by  Henry  R.  Harrower 

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Library 

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TABLE    OF   CONTENTS 


I.    INTRODUCTION 11 

II.    THE  BASIS  OF  ORGANOTHERAPY 19 

1.  An  Introduction  to  Practical  Organotherapy..  19 

2.  Essential    Fundamentals 22 

3.  Failures  with  Organotherapy 26 

4.  The  Pluriglandular  Theory 31 

5.  A  Hypothesis  of  Hormone  Hunger 36 

6.  Diagnostic   Organotherapy 45 

7.  Anaphylaxis  and  the  Endocrines 48 

III.  PLURIGLANDULAR  FORMULAS 53 

IV.  THE  DIAGNOSIS  OP  THE  INTERNAL  SECRETORY 

DISORDERS 79 

1.  The  Frequency  of  Internal  Secretory  Disor- 

ders in  General   Practice 79 

2.  The  Minor  Thyroid  Disorders 84 

3.  The  More  Serious,  Organic  Thyroid  Diseases  96 

4.  A  Method  of  Testing  Thyroid  Function 104 

5.  The  Adrenal  Glands  in  Health  and  Disease....lll 
6    The  Disorders  of  the  Pituitary  Body 120 

7.  Endocrine  Dysfunction  of  the  Male  Gonads....l28 

8.  The  Diagnosis  of  Ovarian  Dyscrinism 132 

9.  The  Diseases  of  the  Thymus 141 

10.  Disturbances  of  the  Parathyroid  Glands 148 

11.  Pancreatic  Endocrine  Dysfunction 151 

12.  Laboratory  Measures  in  Diagnostic  Endocrin- 

ology     153 

V.    EVERY-DAY  ORGANOTHERAPY 161 

1.  Asthenia:     The     Commonest     Symptom     in 

Medicine    161 

2.  Adrenal  Support  in  Tuberculosis 167 

3.  The  Thyroid  Factor  in  Tuberculosis 175 

4.  Pluriglandular    Therapy    in    the    Functional 

Neuroses  180 

5.  The  Treatment  of  Ovarian  Disorders 190 

6.  The  Pituitary  Factor  in  Dysovarism 199 

7.  Asexualism  and  Sterility  in  Women 202 

8.  Galactagogue   Organotherapy  208 

9.  The  Control  of  Menorrhagia _ 212 

10.  \  Routine  Treatment  of  Hyperthyroidism 218 

11.  Glandular  Therapy  for  Defective  Children....228 


603454 


TABLE  OF  CONTENTS 

12.  Epilepsy  from  an  Endocrine  Standpoint 235 

13.  Nocturnal  Enuresis 245 

14.  Hemoglobin:   A  Remedy  for  Anemia 248 

15.  Reducing  High  Blood  Pressure 253 

16.  Organotherapy  in  Asthma 268 

17.  Organotherapy  in  Neuritis 273 

18.  The  Internal  Secretions  in  Rheumatism 277 

19.  The  Endocrines  in  Dermatology 288 

20.  Organotherapy  in  Prostatic  Disorders 296 

21.  The  Hormones  in  Impotence 300 

22.  Intestinal  Stasis  and  the1  Internal  Secretions..308 

23.  The  Mucinase  Theory  in  Mucous  Colitis 315 

24.  Starling's  "Alimentary  Hormone" — Secretin..318 

25.  The   Mineral   Salts  in  Health   and  Disease: 

Remineralization  323 

26.  Renal  Therapy  in  Nephritis 330 

27.  Endocrine  Aspefcts  of  Obesity 334 

28.  Suggestions  in  Simple  Goitre 340 

«V 

VI.    ENDOCRINE  QUERIES  AND  ANSWERS 345 

1.  Arsenic  and  the  Adrenals 345 

2.  Functional  Hypoadrenia  346 

3.  Atypical  Amenorrhea — Thyroid  Origin 347 

4.  Stunted   Growth — Joined   Epiphyses 348 

5.  Hyperthyroidism  without  Exophthalmos 349 

6.  Adrenal  Support  during  Pregnancy 350 

7.  Nausea  of  Pregnancy  a  Protein   Sensitiza- 

tion  350 

8.  The  Diagnosis  of  Endocrine  Epilepsy 351 

9.  The  Endocrines  in  Morphin  Addicts 354 

10.  Efficient  Therapy  in  Menorrhagia 355 

11.  Prostatic  Hypertrophy  356 

12.  Thyroid  Enlargement  in  Girls 357 

13.  Failures  with  Adrenal  Support 358 

14.  Endocrine  Aspects  of  Cold  Hands  and  Feet.. ..359 

15.  Dyscrinism  and  Demineralization 363 

16.  Organotherapy  for  Cancer 364 

17    Abdominal  Pain  following  Ovarian  Therapy..365 

18.  Mental  Deterioration  following  a  Fright 366 

19.  Discrepancies  in  Pluriglandular  Therapy 367 

20.  An  Endocrine  Aspect  of  Pellagra 369 

21.  Syphilis  and  Defective*  Children 370 

22.  Sympatheticotonus  in  Hyperthyroidism 372 

23.  The  Asthenic,  Thin,  but  Wiry  Type 373 

24.  Severe  Asthenia  following  Nasal  and  Sinus 

Infection   374 

25.  Deficient  Mammary  Development 376 

26.  Chronic  Bronchitis 377 

27.  Vomiting  of  Pregnancy 378 

28.  Deficient  Nutrition  in  a  Child 381 

29.  Adrenal  Indigestion 382 


TABLE  OF  CONTENTS  9 

30.  Parkinson's  Disease 384 

31.  Early  Postpartum  Menses 384 

32.  Sympatheticotonus  and  Tuberculosis 386 

33.  Post-Encephalitis  Sequelae 387 

34.  Hypertension  at  the  Menopause1 389 

35.  The  Tonsils  and  the  Thyroid  390 

36.  Some  Points  on  Endocrine  Dosage 391 

37.  Ichthyosis  in  a  Boy 392 

38.  Organotherapy  in   Chorea 393 

39.  Latent  Tuberculosis 394 

40.  Subnormal  Temperature 396 

VII.    APPENDIX 399 

1.  Glossary  of  Terms 399 

2.  Dose  Table 409 

The  Water  in  Fresh  Glands 

Comparative  Price  Table 

3.  The  "Sanitablet"  404 

4.  Our  Ethical   Status 407 

VIII.    INDEX  .  ...409 


PREFACE  TO  THE  THIRD  EDITION 


Appreciation  must  be  expressed  to  many  hundreds  of 
physicians  who  have  commented  favorably  upon  the  two 
previous  editions  of  this  book.  Special  thanks  are  due  to 
many  who  have  "stood  up  for  us",  and  have  labored  with  the 
occasional  physician  who,  seeing  in  my  work  nothing  but  a 
sordid  business  with  its  inevitable  publicity,  have  missed 
the  real  reason  back  of  the  establishment  and  development 
of  my  laboratory,  and  in  their  ignorance  have  criticized  my 
efforts  along  these  lines. 

In  revising  this  third  edition,  I  have  attempted  to  make  it 
more  valuable,  and  have  added  many  chapters  at  the  in- 
stance of  friends  who  felt  that  the  particular  subjects  were 
not  given  as  much  consideration  as  they  should  have  been. 

Many  of  the  older  chapters  have  been  entirely  rewritten, 
and  the  new  section,  "Endocrine  Queries  and  Answers",  will, 
I  believe,  extend  quite  considerably  the  usefulness  of  this 
book  as  a  work  of  reference  to  those  who  are  interested. 

I  have  not  seen  fit  to  prepare  bibliographies,  but  those 
who  are  interested  in  bibliographic  confirmation  can  find  a 
good  deal  of  this  in  the  various  issues  of  Harrower's  Mono- 
graphs on  the  Internal  Secretions  which  is  beginning  its 
second  year  of  successful  publication,  and  pur  librarian  will 
be  pleased  to  assist  physicians  in  gathering  bibliographic 
data  on  subjects  which  may  be  of  interest  to  them. 

This  third  edition,  extended  not  merely  as  far  as  contents 
are  concerned,  but  enlarged  in  the  size  of  the  type  and  also 
of  the  page,  bids  fair  to  be  a  valuable  mirror  of  the  work 
being  done  by  The  Harrower  Laboratory,  and  I  am  making 
use  of  this  opportunity  to  express  my  personal  thanks  to 
literally  thousands  of  physicians  who  have  enabled  us  in  the 
short  space  of  four  years  to  establish  a  business  of  very 
considerable  proportions,  and  to  extend  the  service  that  we 
are  trying  to  render  to  humanity  into  many  homes  where, 
I  am  glad  to  say,  it  has  brought  much  rejoicing. 


Glendale,  California, 
December  1921. 


SECTION   I 

INTRODUCTION 


For  more  than  twelve  years  I  have  been  studying  the 
glands  of  internal  secretion  with  increasing  interest,  and  in 
explanation  of  the  work  of  a  "laboratory  of  applied  endo- 
crinology" now  known  as  "The  Harrower  Laboratory" 
which  was  established  in  the  foothill  city  of  Glendale,  eight 
miles  north  of  Los  Angeles,  California,  in  February,  1918, 
I  must  preface  this  book  with  a  few  remarks. 

The  Object  of  This  Book.  First  of  all,  let  me  explain 
what  this  book  is  intended  to  accomplish  and  why  the  pre- 
vious editions  have  had  so  large  a  distribution  (over  twenty- 
two  thousand  copies  were  printed  and  the  printing  order 
for  this  edition  is  twenty-five  thousand) .  As  will  be  quickly 
seen,  I  have  not  been  satisfied  to  take  the  word  of  the  in- 
vestigator whose  work  has  been  of  an  experimental  char- 
acter and  who  says  that  "the  subject  is  still  in  its  experi- 
mental stages,"  nor  of  the  conservative  editor  who  remarks 
that  "endocrinology  and  especially  organotherapy,  is  still 
in  a  state  of  chaos,"  etc.  When  a  hint  has  come  to  me  I 
have  tried  it  out,  have  made  it  possible  for  many  of  my 
friends  and  correspondents  to  apply  it  clinically  and,  in  the 
course  of  time,  some  real  information,  tested  in  "the  crucible 
of  the  clinic,"  has  been  developed.  I  like  to  say  that  our 
work  has  "materialized  many  ideas  pertaining  to  the  inter- 
nal secretions  in  general  practice ;"  and  to  say  that  many  an 
ephemeral  suggestion  or  half-finished  experimental  hint  has 
been  made  tangible  and  available  to  thousands  of  practising 
physicians,  is  telling  nothing  but  the  truth. 

It  used  to  be  most  aggravating  to  me  to  read  some  inter- 
esting article  and  then  learn  at  its  close  that  "it  may  be 
possible,  as  our  knowledge  develops,  to  apply  these  findings 
in  a  clinical  way  in  suitable  cases."  Now  the  physician  is 
enabled  to  apply  an  idea  with  no  preliminary  bother,  ex- 
pense or  even  trepidation,  for,  in  many  instances,  at  least, 
this  already  has  been  done  by  hundreds  of  others. 

These  prospectively  hopeful  ideas  have  been  materialized 
into  carefully-worked-out,  time-tested  pluriglandular  formu- 

11 


12  PRACTICAL   ORGANOTHERAPY 

las,  and  in  a  generous  percentage  of  the  cases  in  which  they 
have  been  used — not  all  by  any  means,  as  will  be  explained 
in  another  chapter  ("Failures  with  Organotherapy") — they 
have  rendered  a  service  which  has  aroused  admiration  and 
enthusiasm. 

Some  Personal  History.  To  revert  now,  for  a  few  mo- 
ments, to  some  reasons  for  my  enthusiasm  in  this  line  of 
study : 

My  interest  in  the  endocrine  glands  grew  out  of  some 
work  which  I  did  in  1908-9  on  metabolism,  acidemia  and, 
especially,  the  urinary  acidity.  I  wrote  a  number  of  papers 
during  that  period,  some  of  which  appeared  in  prominent 
medical  journals  in  America  and  Europe.  In  asking  myself 
why  faulty  metabolism  and  deficient  cell  chemistry  was 
brought  about  I  could  not  but  consider  the  "regulators  of 
metabolism,"  as  Noel  Paton  calls  them — the  hormones  of 
the  glands  of  internal  secretion. 

After  several  years  of  casual  study  in  Chicago,  I  went 
abroad  for  more  than  two  years,  during  which  time  I  had 
opportunity  to  visit  several  of  the  leading  students  in  this 
field,  in  many  different  countries.  My  enthusiasm  was  con- 
siderably increased  by  what  I  saw  and  heard,  and  it  was 
not  long  before  I  was  convinced  that  we  were  far  behind  our 
European,  and  especially  our  French,  colleagues.  I  have 
since  kept  in  touch  with  many  of  these  men,  and  in  1915-6 
succeeded  in  establishing  the  Association  for  the  Study  of 
Internal  Secretions,  a  body  of  physicians  and  investigators 
whose  object  is  to  further  and  correlate  the  work  of  many 
widely  separated  students  of  endocrinology.  The  Associa- 
tion's bulletin,  Endocrinology,  is  a  splendid  and  compre- 
hensive review  of  the  literature  and  advances  in  this  im- 
portant study.* 

For  years  I  had  been  impressed  with  the  extreme  im- 
portance of  glandular  therapy.  I  had  spent  much  time  and 
effort  to  collate  data  on  organotherapy,  which  was  published 


*  The  above  Association,  now  in  its  fifth  year,  will  welcome  co- 
operation from  interested  physicians.  The  present  President  (Dr. 
Walter  B.  Cannon,  of  Harvard  University,  Cambridge,  Mass.),  or 
Secretary  (Dr.  F.  M.  Pottenger,  Title  Insurance  Bldg.,  Los  Angeles), 
will  be  pleased  to  correspond  with  those  who  desire  to  know  more 
about  the  work  and  aims  of  the  A.  S.  I.  S.  While1  I  am  not  now 
actively  promoting  this  Association,  as  its  originator  and  a  charter 
member,  I  am  glad  to  pass  on  a  word  about  the  excellent  service  it  is 
rendering  to  medicine,  and  especially  about  the  bimonthly  journal 
mentioned  above,  which  is  a  more  than  satisfactory  return  for  the 
annual  dues  of  six  dollars. — H.  R.  H. 


INTRODUCTION  13 

in  book  form — "Practical  Hormone  Therapy" — in  London, 
in  1914,  by  Bailliere,  Tindall  &  Cox.  Naturally,  I  found  out 
some  of  the  wonderful  things  that  were  being  done  in  the 
treatment  of  endocrine  disease ;  and  soon  found  myself  won- 
dering why  so  much  attention  was  paid  to  obvious  thyroid, 
adrenal,  pituitary  or  gonad  disease,  when  the  functions  of 
these  glands  are  of  such  prime  importance  to  the  body  that 
the  slightest  derangement  of  their  hormone  production  must 
in  the  nature  of  things  exert  a  more  or  less  decided  influence 
on  the  body.  In  other  words,  I  began  to  see  the  necessity 
of  studying  the  minor,  functional  ductless  glandular  disor- 
ders, and  the  enthusiasm  engendered  by  the  studies  has 
never  waned  for  an  instant. 

The  Relations  of  the  Endocrine  Glands.  The  next  logical 
step  was  to  investigate  the  effects  that  certain  endocrine 
dysfunction  had  on  the  other  internal  secretory  organs ;  and 
it  was  soon  very  clear  that  to  treat  a  thyroid  disorder  as 
such  just  because  it  was  obviously  of  thyroid  origin  was  to 
ignore  a  fundamental  principle  which  often  has  resulted  in 
failure.  Let  me  explain :  If  a  cretin  or  myxedematous  indi- 
vidual really  has  an  insufficient  production  of  the  thyroid 
hormones,  and  these  internal  secretions  not  only  regulate 
many  important  functions  of  the  body,  but  also  the  en- 
docrine function  of  many  or  all  of  the  other  members  of  the 
internal  secretory  system,  how  is  it  possible  not  to  have 
associated  disorders  due  to  the  resulting  associated  dys- 
crinism  ? 

This  means  that  we  must  consider  the  work  of  the  body  as 
a  whole — of  the  endocrine  glands  as  a  series,  and  when  we 
do  this  we  will  find  that  in  the  hypothyroidism  just  men- 
tioned there  is  also  a  very  well  defined  series  of  disturbances 
in  the  pituitary  gland,  the  sex  glands,  the  adrenals  and,  in 
fact,  in  the  whole  ductless  glandular  system.  Hence  the 
cretin  must  have  more  attention  than  that  given  merely  to 
the  thyroid  insufficiency.  The  same  applies  to  every  form 
of  dyscrinism.  As  has  been  stated  editorially  in  the  New 
York  Medical  Journal  (July  20,  1918)  :  "All  [the  endocrine 
glands]  are  so  closely  bound  to  each  other  that  a  disturb- 
ance in  one  will  throw  out  of  gear  or  out  of  action  all  of 
the  others.  .  .  .  It  is  for  this  reason  that  in  conditions 
thought  to  have  origin  in  this  form  of  disturbance  gland 
medication,  organotherapy,  contemplates  the  giving  of  the 
extracts  of  many  glands." 

Here,  then,  was  my  job:  To  work  out  these  interrelations 
from  a  clinical  and  therapeutic  standpoint ;  and  to  facilitate 


14  PRACTICAL  ORGANOTHERAPY 

the  treatment  of  pluriglandular  disorders  by  suitable  pluri- 
glandular  therapy.  This  for  years  has  been  the  chief  aim 
of  the  writer  and  the  sole  object  of  this  laboratory.  And 
the  results  which  have  accrued,  as  indicated  by  thousands 
of  letters  in  our  files — represented  by  an  occasional  quota- 
tion in  these  pages — are  little  short  of  amazing. 

Pluriglandular  Formulas.  In  considering  how  to  put  this 
laboratory  on  a  satisfactory  and  self-supporting  basis,  I 
decided  in  favor  of  building  a  business  with  certain  organo- 
therapeutic  products  in  order  that  the  profit  derived  from 
their  sale  might  maintain  the  institution  and  that,  as  it 
grows,  opportunities  might  be  afforded  to  develop  the  sug- 
gestions of  colleagues  who,  like  myself,  have  had  more  or 
less  intangible  ideas  which  have  been  difficult  or  impossible 
of  materialization  because  of  limited  finances  or  facilities. 
I  also  felt  that  the  community  of  interests  that  would  result 
from  this  effort  would  automatically  further  the  ideal  which 
I  started  out  to  materialize. 

Having  made  this  decision,  the  most  natural  way  to  start 
seemed  to  be  to  prepare  a  number  of  pluriglandular  for- 
mulas which  I  had  been  in  the  habit  of  prescribing  or 
recommending  to  my  medical  friends,  and  ask  these  friends 
to  use  them  if  they  appeared  reasonable.  These  formulas 
are  given  and  their  therapeutic  possibilities  are  discussed 
in  the  following  pages,  and  your  favorable  consideration  of 
them  is  solicited. 

The  next  development  of  the  work  of  this  laboratory  was 
the  production  from  time  to  time  of  small  experimental 
quantities  of  various  organotherapeutic  preparations  for 
colleagues;  and  already  this  phase  of  our  work  bids  fair  to 
accomplish  much  in  the  way  of  broadening  organotherapy. 
As  I  have  said,  this  was  the  real  underlying  reason  for 
deciding  to  begin  operations.  These  preparations  are 
worked  out  with  or  without  my  own  suggestions  as  required ; 
and  some  very  useful  combinations  already  have  been  de- 
veloped. It  is  a  source  of  great  encouragement  to  me  to  be 
able  also  to  submit  here  a  number  of  them  with  suggestive 
clinical  indications  and  other  data. 

The  Character  of  these  Products.  Wherever  possible  the 
accepted  pharmacopeial  methods  of  standardization  are  fol- 
lowed. For  instance,  the  thyroid  "extract"  contains  the 
prescribed  percentage  of  organically  united  iodine  as  re- 
quired in  the  U.  S.  P.  IX.  Every  effort  is  made  to  insure 
effective  desiccations,  and  I  feel  that  from  the  standpoint 
of  therapeutic  efficacy,  at  least,  the  preparations  of  this 


INTRODUCTION  15 

laboratory  are  not  excelled,  even  in  France  where  the  prac- 
tical application  of  organotherapy  is  still  far  ahead  of  us. 

Aside  from  the  care  in  production  and  standardization, 
there  is  another  very  important  matter  to  which  I  must  call 
attention.  We  have  no  secret  formulas;  no  camouflage  on 
the  labels  or  in  the  literature.  We  do  not  even  use  pro- 
prietary or  trade  names.  There  are  no  indications  upon  the 
labels  and  no  suggestive  enclosures  in  the  packages.  Every 
effort  is  made  to  be  as  honorable  and  professional  as  pos- 
sible; yet  despite  this  no  one  of  the  stock  pluriglandular 
formulas  from  this  laboratory  is  passed  by  the  Council 
of  Pharmacy  and  Chemistry.  A  number  of  them  were  sub- 
mitted, but  they  failed  to  measure  up  to  the  Council's  stand- 
ards, not  in  so  far  as  ethical  standards  are  concerned,  but 
for  the  following  reasons:  "Each  of  the  mixtures  contains 
one  ingredient  or  more,  which  is  neither  recognized  in  the 
U.  S.  Pharmacopeia  nor  admitted  to  New  and  Non-official 
Remedies."  This  means  that  a  glandular  extract  that  has 
not  reached  this  stage  of  acceptation  and  not  been  included 
in  these  lists  is  inadmissible.  In  fact,  in  the  same  letter, 
Professor  Puckner,  from  his  presumably  large  clinical  expe- 
rience, states  that  "there  is  no  evidence  that  many  of  these 
organs  have  any  value  whatever  when  administered  by  the 
mouth  or  in  any  other  way."  This  I  deny  as  vehemently 
as  I  know  how.  I  cannot  gainsay  the  evidence  of  my  own 
experience,  nor  can  I  ignore  the  numerous  statements  made 
to  me  personally  and  in  writing.  Further,  there  is  plenty 
of  evidence  in  current  medical  literature  to  support  any 
reasonably  minded  physician  in  the  use  of,  say,  desiccated 
placenta,  pancreas  substance  or  even  a  spermin-bearing 
extract  from  the  interstitial  cell  of  Ley  dig  from  the  testes. 

The  other  reason  for  judging  these  formulas  as  inadmis- 
sible is  this:  "In  the  light  of  our  knowledge  the  adminis- 
tration of  gland  mixtures  in  the  host  of  conditions  enu- 
merated is  irrational  and  on  a  par  with  the  use  of  the  shot- 
gun mixtures  once  in  vogue."  From  my  own  standpoint,  as 
well  as  that  of  many  others,  I  am  glad  to  say  this  position 
is  altogether  invalid.  First  of  all,  "a  host  of  conditions" 
indeed  follow  derangements  of  the  endocrine  functions 
merely  because  so  many  factors  are  dependent  upon  the 
proper  endocrine  balance.  Secondly,  there  is  a  physiological 
principle,  with  which  Prof.  Puckner  is  probably  not 
acquainted,  and  which  appears  to  regulate  the  capacity 
of  those  organs  that  are  dependent  upon  hor- 
mone stimuli,  to  pick  up  from  the  blood  the  well- 


16  PRACTICAL   ORGANOTHERAPY 

named  "chemical  messengers"  which  they  need  and 
in  the  proportion  that  they  need  them.  (See  the  chapter 
"A  Hypothesis  of  Hormone  Hunger.")  We  must  recall, 
too,  that  the  blood  contains  all  the  hormones  we  know  about 
and  probably  many  more,  as  well  as  the  opsonins,  the 
agglutinins,  the  bacteriolysins,  the  cells,  the  platelets,  the 
salts,  and  so  on — a  "shotgun  mixture"  indeed ;  yet  the  body 
manages  to  make  its  selections  very  satisfactorily.  Pluri- 
glandular  therapy  is  more  rational  than  monoglandular 
therapy,  as  experience  has  shown  a  thousand  times  and  will 
continue  to  show.  The  subject  is  more  fully  discussed  in 
another  section.  In  the  meantime  we  are  trying  to  be  as 
honorable  and  frank  as  we  can,  and  I  personally  believe  that 
I  have  the  right  to  pass  my  own  judgment  and  to  do  as  I 
please  in  the  matter.  Whether  others  agree  with  me  or  not 
is  for  them  to  decide.  //  it  is  a  matter  of  results  and  the 
patient's  best  interests,  the  pluriglandular  idea  is  indeed 
a  very  great  advance  in  organotherapy.  I  confess  that  my 
patients,  my  colleagues  and  the  friends  of  this  laboratory 
are  only  interested  in  results  and  they  are  not  worried  about 
the  ineligibility  or  the  "shotgun"  character  of  the  remedy. 

We  are  making  the  very  best  preparations  available.  The 
contents  are  standardized  when  possible,  the  dosage  is 
accurate,  the  combinations  are  based  upon  long  experience, 
and  time  after  time  the  use  of  these  pluriglandular  stock 
formulas  has  succeeded  when  presumably  indicated  single 
extracts  had  been  used  without  anything  like  the  good 
results  obtained  later. 

Publications  from  This  Laboratory.  For  a  number  of 
years  I  have  been  thinking  about  endocrine  matters  and 
from  time  to  time  I  have  read  a  paper  or  published  an  article 
on  some  subject  in  which  I  was  particularly  interested.  In 
addition  to  this  I  have  written  a  number  of  books,  to  which 
it  may  be  well  to  call  attention  here. 

The  Organotherapeutic  Review.  Quite  the  most  practical 
literature  which  is  sent  out  from  this  laboratory  is  this 
small,  pocket-size,  monthly  journal  which  is  intended  to 
review  the  advances  in  practical  endocrinology  and,  in  par- 
ticular, to  keep  the  profession  in  touch  with  the  progress 
in  the  laboratory.  This  journal  is  eagerly  read  by  many 
thousands  of  physicians,  who  have  come  to  look  forward  to 
its  visits  and  many  of  whom  confess  that  they  are  in  the 
habit  of  slipping  it  into  the  pocket  to  be  read  from  cover 
to  cover  during  an  0.  B.  case  or  at  some  convenient  time. 

The  Review  contains  editorial  articles  by  the  writer  on 


INTRODUCTION  17 

practical  subjects  in  this  field,  a  number  of  brief  abstracted 
or  translated  articles,  and  a  Correspondence  Department  in 
which  questions  pertaining  to  clinical  endocrinology  are 
answered.  This  little  journal  will  be  sent  to  any  physician 
each  month  without  charge,  on  request. 

Harr caver's  Monographs  on  the  Internal  Secretions  is  the 
title  of  a  quarterly  publication.  Each  issue  contains  a  fairly 
comprehensive  study  of  one  subject  gathered  from  widely 
scattered  sources,  arranged  in  a  consecutive  manner  and 
carefully  bibliographed. 

The  issues  for  the  first  year,  1921,  are  as  follows:  1. 
Hyperthyroidism :  Medical  Aspects,  120  pages,  price  $1.50 ; 
2.  Neurasthenia:  An  Endocrine  Syndrome,  92  pages,  price 
51.25;  3.  Epilepsy  as  an  Endocrine  Disorder,  80  pages,  price 
§1.25 ;  4.  Endocrinology  in  Pediatrics,  80  pages,  price  S1.25. 

The  first  issue  for  1922  (No.  5  in  the  series)  is  entitled 
"The  Adrenals  in  Every-day  Medicine,"  and  consists  of  a 
very  comprehensive  review  of  this  practical  subject  with 
many  quotations  and  translations  from  foreign  sources. 
(120  pages,  price  $1.50.)  Future  issues  will  take  up  such 
subjects  as  Hypertension;  Impotence  and  Sterility;  Defec- 
tive Growth,  Mentality  and  Nutrition  in  Children;  The 
Endocrine  Aspects  of  Obesity;  and  Endocrine  Headaches: 
Their  Diagnosis  and  Treatment. 

The  annual  subscription  price  in  the  U.  S.  is  $3.00,  and 
abroad,  S3.50.  Individual  issues  may  be  secured  postpaid 
at  the  prices  indicated. 

"Essays  on  the  Internal  Secretions."  For  some  years  I 
have  conducted  a  Prize  Essay  Contest,  each  year  offering 
$500  in  cash  as  prizes  for  a  series  of  essays  on  the  internal 
secretions.  This  has  stimulated  quite  an  interest  among 
some  physicians,  both  here  and  abroad,  and  already  two 
volumes  of  quite  interesting  matter  have  appeared  entitled 
"Essays  on  the  Internal  Secretions — 1920"  and  "1921",  re- 
spectively. 

These  contain  practical  essays  on  various  endocrine  mat- 
ters from  the  viewpoints  of  as  many  physicians  as  there  are 
essays.  Many  of  the  authors  are  world-known  authorities 
on  this  subject. 

As  heretofore,  this  contest  has  begun  about  the  middle 
of  the  year  and  closed  in  November.  The  prizes  were 
awarded  and  the  collections  of  essays  have  appeared  early 
in  the  following  year — each  volume  bearing  the  date  of  the 
previous  year.  The  price  of  each  copy  is  $2.50.  Informa- 
tion regarding  the  rules  of  the  contest  will  be  sent  on  request 


18  PRACTICAL   ORGANOTHERAPY 

to  Glendale,  and  any  or  all  of  the  books  will  be  sent  to 
physicians  on  approval. 

"A  List  of  Books  on  the  Internal  Secretions."  To  accom- 
modate a  growing  number  of  physicians  with  literary  infor- 
mation this  pamphlet  of  64  pages  is  published.  It  is  sent 
gratis  to  subscribers  for  Harrower's  Monographs,  and  may 
be  had  by  others  at  50  cents  postpaid. 

A  Library  Service.  For  years  we  have  been  collecting 
clippings  and  reprints  on  every  phase  of  endocrinology  and, 
especially,  organotherapy.  Thousands  of  index  cards  and 
published  items  are  available  to  visiting  physicians.  We 
receive  literally  hundreds  of  medical  periodicals  in  seven 
languages  and  all  are  read  and  clipped  for  the  things  of 
interest  to  us.  Every  obtainable  book  on  the  subject  is  in 
our  library,  and  many  times  we  have  been  able  to  render 
a  very  helpful  service  to  correspondents. 

The  object  of  The  Harrower  Laboratory  is  to  broaden 
medicine  by  developing  the  practically  applicable  things  in 
the  internal  secretions.  The  chosen  motto  is,  "At  YOUR 
Service." 


SECTION  II 

THE  BASIS  OF  ORGANOTHERAPY 


In  this  section,  I  have  attempted  to  set  down  the  funda- 
mentals upon  which  present-day  organotherapy  has  been 
built.  These  ideas  are  based  upon  the  opinions  of  many. 
Not  all  may  agree  with  them  and,  especially,  some  of  the 
practical  deductions;  but,  nevertheless,  they  have  been 
tested  clinically  too  many  times  to  be  as  bad  as  some  would 
have  them.  A  knowledge  of  these  ideas  will  give  the  reader 
a  working  understanding  of  the  "why"  and  "how"  of  a  much 
misunderstood  but  extremely  valuable  branch  of  therapeutic 
medicine. 

SECTION  II.     CHAPTER  I 

AN  INTRODUCTION  TO  PRACTICAL 
ORGANOTHERAPY 


Since  the  remote  days  of  Hippocrates  and  Galen,  and  even 
of  Brown-Sequard,  the  "sponsor  of  scientific  organo- 
therapy," the  administration  of  preparations  of  animal 
organs  has  been  used  and  discarded  and  used  again.  It  is 
indeed  a  study  of  perennial  interest  and  at  no  time  has  this 
subject  attained  so  great  and  increasing  a  vogue  as  in  these 
last  few  years.  Without  a  doubt,  the  extent  of  this  interest 
has  resulted  from  the  stories  of  remarkable  results — 
a  physician  cannot  keep  a  good  thing  from  his  colleagues 
very  long — and,  not,  as  some  would  have  it,  because  of  the 
aggressive  manner  in  which  we  have  developed  our  work. 

There  are  four  principal  reasons  for  this  interest: 

(1)  Many  experimental  and  clinical  experiences  have 
developed  intelligible  reasons  for  previous  empirical  prac- 
tices ; 

(2)  The  production   and   standardization  of  glandular 
"extracts"  (as  they  still  are  erroneously  called)  has  attained 
a  degree  of  excellence  which  far  exceeds  the  work  of  pre- 
vious years; 

19 


20  PRACTICAL   ORGANOTHERAPY 

(3)  The  results  following  tfie  use  of  organotherapeutic 
preparations  sometimes  are  astonishing,  even  though  other 
measures  calculated  to  secure  benefit  have  been  tried  again 
and  again  with  little  or  no  advantage. 

(4)  The  development  of  the  relation  of  the  endocrine 
glands  and  of  glandular  synergisms  above  all  other  things, 
has  put  a  new  aspect  upon  the  whole  subject  which  has 
attained  practical  value  through  the  application  of  pluri- 
glandular  therapy. 

There  is  an  immense  literature  on  the  subject.  In  my 
recently  published  "List  of  Books  on  the  Internal  Secre- 
tions" (referred  to  previously)  are  Msted  no  less  than  400 
books  devoted  to  the  internal  secretions,  the  ductless  glands, 
their  pathology  and  other  intimately  allied  subjects.  Per- 
haps one-half  of  these  are  in  the  English  language.  Besides 
these  books  there  are  literally  thousands  of  articles  and 
reports  on  the  therapeutics  that  this  increasing  knowledge 
has  made  possible.  The  study  of  organotherapy  or,  as  it  has 
been  called,  "hormone  therapy,"  is  daily  gaming  in  scope 
and  prestige. 

Over  two  years  of  study  in  this  field  in  Europe,  with  nu- 
merous visits  to  Paris — admitted  to  be  the  seat  of  learning 
in  the  science  of  "opotherapie" — Berlin,  Brussels,  Copen- 
hagen, Amsterdam,  London  and  Edinburgh,  caused  me  to 
have  a  much  greater  respect  for  the  subject  which  did  not 
seem  to  be  in  particularly  good  repute  when  I  left  America 
in  1912.  Many  conversations  with  leading  investigators  in 
various  phases  of  the  subject,  stimulated  my  interest.  The 
literature  was  studied  and  a  large  file  of  clippings  and  re- 
prints accumulated.  Soon  it  appeared  that  much  of  this 
information  was  worth  collating  and  I  therefore  prepared 
the  manuscript  for  a  book  that  would  introduce  interested 
readers  to  an  extremely  broad  and  fascinating  subject  which 
is  passing  from  the  stage  of  academic  discussion  to  that  of 
great  clinical  value  in  the  routine,  every-day  practice  of 
medicine. 

"No  subject  will  prove  more  enthralling  to  the  interested 
reader  than  the  possibilities  of  hormone  therapy,  not  only 
in  the  obvious  disorders  of  the  endocrine  glands,  but  in  many 
other  diseases  evidently  amenable  to  treatment  with  their 
products.  Nor  will  the  interest  wane  when  plausible  theories 
have  become  tangible  results;  for  the  possibilities  of  this 
method  are  almost  limitless;  nor  is  its  chemical  basis  de- 
pendent on  the  unsupported  experiences  of  a  few  enthusias- 
tic investigators." 


THE  BASIS  OF  ORGANOTHERAPY  21 

Strangely  enough,  until  the  year  1914,  there  was  no  book 
in  English  which  thoroughly  covered  the  practical  side  of 
this  subject  and  as  mentioned  in  the  Introduction,  it  was 
my  privilege  to  publish,  just  before  the  European  war,  a 
book  called  "Practical  Hormone  Therapy."*  In  this  book  an 
attempt  was  made  to  collate  in  a  more  or  less  comprehen- 
sive fashion  a  majority  of  the  most  important  facts  relating 
to  the  many  branches  of  the  therapeutics  made  possible 
by  the  advance  in  our  knowledge  of  the  internal  secretions 
and  the  organs  producing  them.  This  information  covers 
such  a  wide  field  that  the  data  was  divided  into  8  sections 
and  36  chapters.  To  facilitate  the  study  of  this  subject, 
I  added  a  glossary  of  terms,  many  of  which  are  now  included 
in  the  medical  dictionaries,  an  organotherapeutic  dose-table 
and  a  series  of  bibliographies  directing  attention  to  no  less 
than  793  references,  the  largest  proportion  of  which  directly 
concern  the  practical  side  of  organotherapy. 

The  physician  who  is  sufficiently  interested  to  look  up 
some  of  the  bibliographic  references  to  these  various  sub- 
jects, soon  will  be  convinced  of  the  reasonableness  of  many 
of  the  facts  and  suggestions  which  have  been  gathered 
there,  and  a  much  more  complete  series  of  references  will 
be  opened  up  to  the  student,  for  the  bibliographies  of  the 
800  articles  indexed  in  "Practical  Hormone  Therapy"  direct 
one  to  at  least  4,000  additional  communications!  So  much 
for  the  larger  book  which,  I  am  glad  to  say,  has  been  ex- 
tremely well  received  and  reviewed. 

There  is  no  doubt  that  many  a  difficult  case  will  prove  to 
be  amenable  to  organotherapy,  even  after  several  other 
things  have  failed.  I  frequently  find  myself  recalling  ex- 
periences in  my  practice  of  years  ago,  that  I  am  confident 
could  have  been  simplified  with  practically  no  trouble — had 
I  known  what  I  now  know  about  organotherapy.  Twelve 
years  ago  we  did  not  have  corpus  luteum  or  pituitary  extract 
to  help  us  as  wonderfully  as  they  sometimes  do  now.  It  is 
hoped  that  the  facts  collated  here  may  prove  to  be  fre- 
quently serviceable  to  those  into  whose  hands  this  book 
may  come,  and  it  will  be  a  pleasure  to  hear  from  interested 
readers  with  criticisms,  comments,  experiences  or  requests 
for  cooperation. 

The  section  which  follows  comprises  in  truth  the  merest 
outlines.  No  attempt  is  made  to  explain  the  "why"  and 

*  This  book  is  at  present  out  of  print  though  some  day  it  may  be 
rewritten. 


22  PRACTICAL   ORGANOTHERAPY 

the.  "how."  The  essential  physiologic  basis  or  explanation 
is  missing,  as  space  is  not  available  either  for  this  informa- 
tion or  for  the  numerous  clinical  experiences  and  reports 
which  might  supplement  it,  many  of  which  may  be  found  in 
my  other  books,  or  scattered  throughout  the  literature  of  a 
dozen  countries. 

Here  is  offered  the  "real  meat" — the  boiled-down  essen- 
tials of  a  subject  which,  according  to  Leonard  Williams, 
"already  unfolds  before  the  astonished  view  of  the  seeing 
eye,  a  land  of  promise  besides  which  the  discoveries  of  Lis- 
ter and  Pasteur  are  destined  to  pale  into  honorable  insig- 
nificance." 


SECTION  II.     CHAPTER  2 
THE  ESSENTIAL  FUNDAMENTALS 


The  literature  on  organotherapy,  especially  that  which 
has  been  published  during  the  last  ten  years,  is  both  vast 
and  comprehensive;  and  marshals  unnumbered  facts  which 
have  placed  this  most  ancient  and  altogether  empiric  form 
of  therapeutics  upon  a  scientific  and  up-to-date  basis.  The 
ductless  glands  have  been  studied  with  enthusiasm  and 
thoroughness,  and  their  importance  is  being  more  generally 
recognized  because  both  the  physiologists  and  the  patholo- 
gists  have  definitely  shown  us  a  part,  at  least,  of  their  func- 
tions and  connected  their  researches  with  many  heretofore 
unsolved  medical  puzzles. 

General  Considerations.  The  status  of  the  hormones,  or 
the  active  principles  obtained  from  certain  glands  of  inter- 
nal secretion  secured  from  animals,  and  their  use  as  reme- 
dial agents,  has  arrived  at  a  place  which  reaches  well  beyond 
the  laboratory  of  the  physiologist.  These  active  principles 
are  undoubtedly  specific  substances,  and  some  of  them 
already  have  been  isolated  while  others  are  obviously  pres- 
ent although  they  have  not  yet  been  chemically  separated. 
These  substances  have  been  given  the  convenient  generic 
name  "hormone"  from  the  Greek,  "I  arouse,"  or  "set  in 
motion,"  and  are  now  known  to  constitute  a  series  of  im- 
portant chemical  messengers  by  means  of  which  the  func- 
tions of  the  body  are  correlated. 

Each  hormone — sometimes  an  organ  has  the  faculty  of 
producing  two  or  more  hormones — has  the  inherent  capacity 


THE  ESSENTIAL  FUNDAMENTALS  23 

of  exciting  to  definite  activity  those  cells  for  which  it  mani- 
fests a  special  affinity  (in  this  connection  note  the  chapter 
entitled,  "A  Hypothesis  of  Hormone  Hunger"),  and  we  are 
just  beginning  to  appreciate  the  considerable  importance 
which  attaches  to  the  normal  production  of  these  different 
hormones,  as  well  as  to  the  maintenance  of  the  balance 
which  is  brought  about  by  the  action  and  interaction  of 
these  variously  acting  bodies. 

While  organotherapy  is  undoubtedly  the  oldest  form  of 
therapeutics,  it  has  become  the  newest,  for  the  good  reason 
that  the  discovery  of  the  hormones  and  their  influence  upon 
physiology  has  enabled  the  students  of  the  past  ten  or  fifteen 
years  to  give  a  reason  for  many  clinical  phenomena  and  thus 
establish  the  empirical  procedure  of  Hippocrates,  Galen  and 
others  of  ancient  and  more  modern  times,  upon  a  scientific 
and  unquestioned  basis. 

Pharmacy  has  contributed  its  share  to  the  growth  of  this 
phase  of  therapeutics,  and  much  work  has  been  done,  es- 
pecially in  France  and  America,  to  produce  therapeutically 
active  as  well  as  convenient  preparations  with  which  to  apply 
in  a  practical  way,  the  fundamental  principles  which  have 
been  laid  bare. 

Four  Principles.  These  fundamental  principles  have  been 
grouped  under  four  chief  heads  under  which  the  various 
organotherapeutic  procedures  may  be  classified  conveni- 
ently. These  forms  of  organotherapy  are  as  follows: 

1.  Substitutive.  3.  Empirical. 

2.  Homostimulative.  4.  Specific. 

A  very  brief  consideration  of  each  of  these  four  forms 
of  organotherapy  will  explain,  in  part,  its  scientific  basis, 
and  enable  the  interested  reader  to  classify  the  animal 
extracts  from  a  therapeutic  standpoint,  though  in  a  some- 
what different  manner  from  the  classification  used  in  the 
subsequent  pages  in  which  the  various  organotherapeutic 
products  are  arbitrarily  divided  into  three  classes  according 
to  their  present  popularity  and  therapeutic  availability. 

Substitutive  Organotherapy.  Properly  prepared  extracts 
of  various  glands  supply  a  deficient  physiological  secretion 
of  organs  that  correspond  to  those  from  which  the  extracts 
are  made.  The  disorder  may  be  due  to  absence,  atrophy  or 
functional  inactivity  of  these  organs,  i.  e.,  the  production 
of  their  normal  active  principles  has  been  reduced  or 
stopped.  A  typical  illustration  of  this  category  is  the  use 
of  thyroid  extract  to  replace  the  secretion  which  is  missing, 
as  in  myxedema. 


24  PRACTICAL  ORGANOTHERAPY 

Homostimulative  Organotherapy.  The  active  principles 
of  the  internal  secretory  organs  have  a  definite  stimulative 
and  restorative  action  upon  the  glands  corresponding  to 
those  from  which  the  extracts  are  made.  It  has  been  re- 
marked by  some  French  writers  that  organic  extracts  exert 
a  regulative  action  upon  the  organs  from  which  they  are 
derived,  not  only  favoring  the  restoration  of  their  func- 
tions, but  also  of  their  normal  anatomic  structure.  Hallion 
is  prominent  among  these  and  his  "law"  briefly  states  this 
principle  as  follows: 

"Extracts  of  an  organ  exert  on  the  same  organ  an  exciting 
influence  which  lasts  for  a  longer  or  shorter  time.  When 
the  organ  is  insufficient,  it  is  conceivable  that  this  influence 
augments  its  action,  and,  when  it  is  injured,  that  it  favors 
its  restoration." 

This  principle  is  the  basis  of  a  large  share  of  the  value 
of  organotherapy,  and  is  represented  quite  typically  by  the 
use  of  bile  in  hepato-biliary  insufficiency,  or  ovarian  prepara- 
tions in  functional  ovarian  disorders. 

Empirical  Organotherapy.  Certain  animal  extracts  seem 
to  influence  certain  clinical  manifestations  and  as  a  result 
have  come  to  be  used  without  a  definite  and  acceptable 
scientific  basis.  Examples  of  this  form  of  organotherapy 
are  the  pituitary  treatment  of  functional  Ovarian  disorders, 
or  the  parathyroid  treatment  of  paralysis  agitans. 

Incidentally,  as  our  appreciation  of  the  intricacies  of  the 
endocrine  relations  grows,  the  empirical  use  of  organother- 
apy will  disappear  and  in  its  place  we  will  put  some  other 
form.  Already  this  may  be  true  of  the  two  examples  just 
mentioned. 

Specific  Organotherapy.  Finally,  it  has  been  found  that 
extracts  of  certain  organs  exert  a  definite  physiological  in- 
fluence, not  by  virtue  of  a  homostimulative  action,  but  by 
causing  certain  physiologic  activity,  or  by  counteracting 
some  particular,  morbid  symptoms  not  due  to  any  change  in 
the  internal  secretory  action  of  the  glands  of  the  patient. 
The  most  decided  and  remarkable  type  of  this  class  of 
organotherapeutic  remedies  is  the  extract  of  the  posterior 
lobe  of  the  pituitary  body  represented  by  Liquor  Hypophy- 
sis, U.  S.  P.  IX  ( Harrower),  and  its  effect  upon  the  uterine 
muscle,  especially  during  labor. 

Until  quite  recently  it  was  the  exception  rather  than  the 
rule  to  find  physicians  having  every-day  recourse  to  the 
various  hormone-bearing  products,  and  while  the  adminis- 
tration of  thyroid,  adrenal,  ovarian  and  pituitary  extracts 


THE  ESSENTIAL  FUNDAMENTALS  25 

is  quite  general,  it  should  be  remembered  that  their  thera- 
peutic value  was  demonstrated  before  we  knew  that  their 
activity  was  really  in  their  contained  hormones — before  our 
present  more  extended  knowledge  of  this  subject  had  been 
attained. 

It  seems  quite  reasonable  to  presume  that  if,  say,  desic- 
cated sheep's  thyroids  suffice  to  supply  the  lack  brought 
about  by  thyroid  insufficiency  in  the  human,  and  that  other 
glandular  extracts  serve  to  produce  equally  valuable  thera- 
peutic results,  hormones  produced  in  the  glands  of  animals 
deserve  to  be  more  generally  used  as  remedies;  and  the 
administration  of  the  various  specific  glandular  activators 
should  become  both  a  common  and  important  factor  in  the 
practice  of  medicine. 

Favoring  Cellular  Rest.  It  has  been  previously  remarked 
that  the  administration  of  glandular  extracts  frequently 
serves  as  an  actual  stimulus  to  the  work  of  the  organ  cor- 
responding to  that  from  which  the  extract  was  made.  This 
may  be  accomplished  by  temporarily  relieving  certain  over- 
worked cell  collections  from  the  necessity  of  manufactur- 
ing their  normal  product,  and  thus  allowing  them  rest,  to 
recuperate  and  regain  their  lost  or  diminished  function. 
Again,  this  action  may  be  brought  by  the  specific  influence 
which  these  hormones  are  presumed  to  exert  upon  the  pre- 
cursors of  hormones  in  corresponding  organs — it  has  been 
quite  thoroughly  established  by  Hallion,  of  Paris,  that  the 
administration  of  secretin  in  addition  to  bringing  about  the 
activation  of  various  digestive  zymogens  and  their  liberation 
from  the  pancreas,  liver  and  intestine,  definitely  favors  the 
production  of  an  increased  quantity  of  the  precursor  of 
secretin  (prosecretin)  in  the  duodenum  itself,  as  well  as 
causing  an  increase  in  the  blood  supply  to  that  particular 
part.  In  other  words,  the  ingested  hormones  also  may  be 
"made  over"  or  used  again,  just  as  bile  is  reused  by  the  liver 
after  its  alimentary  service  has  been  accomplished.  Another 
equally  important  field  of  usefulness  for  the  hormones  is  to 
supply  immediately  to  the  system  substances  for  which  it 
is  craving  as,  for  example,  the  use  of  the  dynamogenic  prin- 
ciples which  regulate  the  so-called  "adrenal  system"  and 
which  are  deficient  in  asthenic,  run-down  states,  or  ovarian 
extract  in  the  disorders  which  follow  the  artificial  meno- 
pause, etc. 

If  it  is  possible  to  procure  from  animals  the  substances 
which  serve  to  activate  certain  of  their  functions,  and  by 
introducing  them  into  the  human  body,  to  accomplish  for 


26  PRACTICAL  ORGANOTHERAPY 

the  patient  what  these  were  intended  to  have  done  for  the 
animal,  is  there  not  a  most  reasonable  philosophy  and  foun- 
dation for  the  more  general  application  of  hormone  therapy? 

As  Leonard  Williams,  of  London,  remarked  in  the  preface 
to  his  book,  "Minor  Maladies":  "I  believe  that  the  serious 
study  of  what  are  called  'minor  maladies'  will  lead  to  the 
prevention  and  forestalling  of  many  serious  diseases.  Still 
more  earnestly  do  I  believe  that  the  study  of  the  whole  field 
of  the  internal  secretions  will  enable  us  to  detect  and  cor- 
rect morbid  tendencies  with  a  degree  of  success  which  has 
been  denied  to  the  older  methods.  The  microbe — the  seed 
— has  ruled  the  immediate  past;  the  future  is  with  the  soil, 
the  endocrine  glands." 

It  must  be  remembered  that  the  dosage  of  products  that 
are  active  as  a  result  of  their  hormone  content  has  quite  a 
different  basis  from  that  of  drugs:  There  is  no  definite 
dosage,  save  "dose  enough."  Joseph  Pratt,  of  Boston,  has 
said :  "As  all  internal  secretions  are  stimulatory  substances 
and  do  not  furnish  nutritive  material  to  the  cells,  they  are 
able  to  exert  their  specific  action  when  present  in  very 
small  quantities." 

To  one  who  uses  the  hormone-bearing  extracts  for  any 
length  of  time,  and  who  thus  has  an  opportunity  to  appre- 
ciate their  specificity  and  value,  the  subject  assumes  a  most 
important  aspect,  since  it  makes  possible  results  otherwise 
unattainable.  In  the  words  of  Leonard  Williams,  this  is  "a 
subject  of  inquiry  as  fascinating  as  any  in  the  whole  range 
of  medicine,  and  as  fruitful  in  promise  as  any  in  the  whole 
range  of  therapeutics." 


SECTION  II.     CHAPTER  3 
FAILURES   WITH   ORGANOTHERAPY 


As  with  every  phase  of  the  treatment  of  disease  we  expect 
to  encounter  a  certain  proportion  of  failures  with  the  ad- 
ministration of  organotherapeutic  preparations.  It  could 
hardly  be  otherwise,  for  we  have  not  found  the  long-sought 
"Elixir  Vitae"  which  Ponce  de  Leon  and  others  have  vainly 
looked  for. 

If  we  are  wise,  our  failures  will  become  our  greatest 
assets,  for  through  them  we  may  learn  more  than  in  any 


FAILURES  WITH  ORGANOTHERAPY  27 

other  way.  A  graduate  from  the  "University  of  Hard 
Knocks"  always  is  a  better  posted  and  more  dependable 
man  than  the  one  who  has  secured  most  of  his  information 
easily  by  avoiding  the  failures  of  others,  though,  naturally, 
our  course  in  this  "university"  can  be  shortened  materially 
by  being  awake  to  what  others  are  doing. 

During  my  experience  I  have  often  heard  statements 
something  like  this :  "I  tried  that  treatment  faithfully  for 
several  weeks,  and  it  seemed  to  do  no  more  good  than  other 
things  we  used  before.  I'm  afraid  I  haven't  much  use  for 
.  .  .  ." — corpus  luteum,  mammary  extract,  or  even  thy- 
roid gland  have  been  mentioned.  At  times  organotherapy 
as  a  whole  thus  has  been  criticized,  despite  the  apparent 
limitations  of  the  speaker's  clinical  testing. 

This  profitably  may  be  used  as  the  text  for  a  short 
"sermon"  which  may  develop  some  helpful  suggestions  for 
those  who  are  expecting  great  things  from  organotherapy, 
and  to  whom  it  may  be  a  somewhat  new  procedure. 

The  Usual  Run  of  Cases.  First  of  all  we  must  admit  that 
usually  organotherapy  has  been  tried  in  difficult  cases  of 
long  standing  where  other  measures  have  been  tried,  per- 
haps repeatedly  and  by  many  physicians,  and  have  failed. 
Here,  naturally,  the  results  will  be  less  satisfactory  just 
as  any  treatment  is  likely  to  be  less  effective  the  further 
advanced  and  more  complex  is  the  disease.  It  is  true  that 
organotherapy  deserves  consideration  in  just  this  class  of 
cases,  for  it  has  been  remarked  many  times  that  when  other 
things  have  failed,  organotherapy  has  enabled  us  to  get 
wonderful  results,  and,  perhaps,  we  may  have  acquired  an 
undue  enthusiasm,  and  expect  too  much  of  this  method. 
None  the  less  we  must  not  deprecate  organotherapy  for  this 
reason  merely  because  we  cannot  use  it  to  accomplish  the 
impossible. 

There  is  another  very  important  factor  that  sometimes 
seems  purposely  to  be  ignored,  especially  by  those  who  don't 
want  to  be  convinced!  We  have  seen  that  the  real  basis  for 
the  benefits  to  be  expected  from  organotherapy  lies  in  the 
principle  of  homostimulation.  This  means  that  we  must 
have  active  preparations  and  responsive  organisms.  It  is 
possible  to  have  an  inactive  remedy,  I  will  admit,  though 
in  these  days  such  products  far  excel  those  of  years  ago; 
but  how  about  the  reactivity  of  the  patient  and  the  response 
of  those  cell-aggregates  that  it  is  desired  to  arouse  or  set 
into  renewed  motion?  Especially  in  chronic  disease  where 
the  conditions  are  results  of  constant  and  long-continued 


28  PRACTICAL   ORGANOTHERAPY 

irritation,  malnutrition  or  toxemia,  the  reeducation  of  the 
worn-out  endocrine  glands  is  no  small  task.  And  too,  the 
degree  to  which  the  endocrine  glands  are  affected  in  one 
case  as  compared  with  another  seemingly  quite  similar, 
varies  very  much  indeed.  Again,  there  is  a  very  decided 
though  intangible  individual  element,  for  one  person  re- 
sponds to  hormone  stimuli  rapidly  and  thoroughly,  while 
another  does  not.  One  child  "catches  everything  going," 
while  another  "has  never  been  sick  in  her  life."  It  is 
merely  a  matter  of  the  physiological  substratum — and  this 
indeed  is  an  indefinite  quantity. 

Nevertheless  we  will  continue  to  use  organotherapy 
expecting  a  certain  percentage  of  delayed  results  and  even 
some  entire  failures,  and  are  more  than  satisfied  with  the 
numerous  excellent  responses  to  the  natural  hormone  stimuli 
that  the  administration  of  glandular  extracts  makes  pos- 
sible. 

Need  for  Prolonged  Treatment.  Another  cause  of  failure 
is  due  to  stopping  before  one  should.  In  our  "text"  above, 
"several  weeks"  is  the  time  stated  as  being  the  limit  of  the 
doctor's  patience.  Now  organotherapy  is  useful  largely  be- 
cause it  is  a  means  of  educating  certain  organs  to  perform 
their  service  to  the  body  as  a  whole.  Education  is  not  a 
matter  of  days  or  even  weeks.  It  takes  many  years  to 
educate  the  mind.  The  gastro-enterologist  knows  that  it 
takes  months  to  educate  the  liver,  gastric  cells  or  other 
organs  to  perform  the  task  which  through  various  circum- 
stances has  been  given  up  or  done  unsatisfactorily.  When 
we  give  morphia  we  expect  practically  immediate  results. 
It  works  quickly,  not  by  "education"  but  by  paralyzing  cer- 
tain functions.  Strychnia  also  works  quickly,  not  by  "edu- 
cation" but  by  abnormal  stimulation,  and  how  long  do  such 
effects  last? 

As  a  matter  of  fact,  the  subtle  influence  of  hormone 
therapy  is  indeed  a  reeducation  of  certain  organs,  and  this 
always  takes  time  and,  as  we  have  seen  before,  depends  a 
great  deal  upon  the  responsiveness  of  the  cells.  To 
be  successful  organotherapy  should  be  added  to  other 
treatment,  drug,  hygienic  or  dietetic,  and  should  be  con- 
tinued always  for  a  generous  time;  and  further,  it  should 
be  "tapered  off"  to  see  how  well  the  endocrine  glands  can 
get  along  without  these  additional  stimuli. 

The  Pluriglandular  Idea.  Still  another  potent  cause  of 
failure  is  the  not  unusual  tendency  to  ignore  the  intimacy 
of  the  ductless  glands  and  their  most  important  interrela- 


FAILURES  WITH  ORGANOTHERAPY  29 

tions.  The  subject  of  reenforcing  this  extract  or  that  is 
given  comprehensive  consideration  elsewhere  in  this  book; 
and  I  merely  mention  as  one  of  the  causes  of  failure,  a  habit 
of  overlooking  associated  derangement  of  other  glands 
which  are  dependent  upon  or  at  least  associated  with,  the 
particular  ductless  gland  which  may  have  been  discovered 
to  be  at  fault  and  which  is  being  treated  with  organotherapy. 
In  other  words,  combining  synergist  gland  extracts  is  likely 
to  make  for  better  results;  and  here,  let  me  say  with  em- 
phasis, is  the  "open  sesame"  to  the  successful  application 
of  organotherapy  in  a  generous  percentage  of  all  cases  in 
which  this  measure  is  indicated.  I  have  repeatedly  asserted, 
and  it  has  not  yet  been  denied,  that  it  is  not  possible  for 
a  single  endocrine  organ  to  be  affected,  slightly  or  seriously, 
without  reflex  (hormonic)  effects  upon  others  of  the  allied 
organs. 

This  aspect  of  the  matter  is  so  important  that  it  is  given 
more  consideration  in  several  chapters  of  this  book.  The 
"pluriglandular  idea"  is  as  great  an  advance  as  has  been 
made  in  organotherapy  despite  a  few  criticisms  from  those 
without  clinical  experience  who,  having  at  one  time  defi- 
nitely committed  themselves  as  opposed  to  such  "shotgun 
methods,"  must  now  keep  up  the  fiction,  or  be  turncoats! 
Useful  in  Functional  Disorders.  There  has  been  a  good  deal 
of  comment,  especially  in  some  manufacturers'  literature, 
about  the  organotherapeutic  treatment  of  certain  organic 
diseases,  especially  of  the  central  nervous  system.  These 
statements  have  led  some  to  expect  "cures"  in  such  diseases 
as  locomotor  ataxia,  multiple  sclerosis,  paralysis  and  other 
diseases  generally  conceded  to  be  "incurable."  I  do  not 
deny  that  increased  endocrine  function  is  likely  to  be  helpful 
in  an  organism  afflicted  with  such  diseases  as  those  men- 
tioned just  as  in  any  others,  but  it  does  not  replace  the 
destroyed  nerve  cells,  and  can  not.  Organotherapy  may  be 
indeed  helpful  in  such  hopeless  cases,  but  it  is  far  from 
curative  and  it  should  be  obvious  that  if  this  method  really 
cured  locomotor  ataxia,  the  manufacturers  and  their  for- 
tunate medical  customers  would  never  lack  either  opportu- 
nities to  serve  or  the  financial  rewards  which  would  natur- 
ally come  with  such  a  service.  Organic  disease  is  not  amen- 
able to  organotherapy  in  the  degree  that  we  expect  func- 
tional disease  to  respond  to  it — it  simply  cannot  be  so. 

The  One  Great  Cause  of  Failure.  Finally,  quite  the  most 
important  of  all  the  causes  of  failure  with  organotherapy 
(and,  for  that  matter,  any  other  method  of  treatment)  is 


30  PRACTICAL  ORGANOTHERAPY 

an  incomplete  diagnosis.  Too  often  we  learn  what  is  the 
matter  with  our  patient,  but  not  all  that  is  wrong.  I  have 
repeatedly  stated  that  the  medical  profession  commits  more 
sins  of  omission  than  of  commission.  We  overlook  things. 
Why,  the  minor  form  of  hypothyroidism  is  more  than  com- 
monly ignored  entirely !  The  consideration  of  the  endocrine 
side  of  the  ordinary  troubles  which  are  met  every  day  in 
general  practice  has  been  passed  by  until  very  recently. 
Disorders  of  the  ductless  glands  had  to  be  "real  diseases" 
before  we  recognized  them,  and  hidden  functional  aberra- 
tions were  never  sought  for.  Now  all  is  being  changed  and 
as  our  eyes  are  being  opened  to  the  importance  of  functional 
pathology  not  only  are  we  recognizing  the  early  influence 
of  endocrine  dysfunction,  but  we  are  learning  to  consider 
our  patient  as  a  whole  rather  than  as  an  individual  with 
some  obvious  disease. 

Here,  then,  lies  the  greatest  source  of  failure  in  medicine 
— we  have  been  treating  diseases  rather  than  patients!  So 
long  as  we  consider  a  case  of,  say,  hypothyroidism  as  being 
suited  for  organotherapy  and  ignore  the  demineralization, 
the  acidosis  or  hypoalkalinity  or  the  original  active  cause 
of  the  disturbance — some  hidden  focal  infection,  a  dilated 
and  overloaded  colon,  a  dietetic  habit  (such  as  coffee-drink- 
ing) which  has  overburdened  the  detoxicating  department 
of  the  body  or  other  common  underlying  causes  of  disease— 
we  are  not  going  to  get  the  optimal  results  from  our 
organotherapy. 

The  reverse  is  equally  true— even  if  we  are  most  thorough 
in  our  diagnosis,  and  our  clinical  and  laboratory  findings 
are  about  perfect,  we  can  reduce  the  efficacy  of  our  treat- 
ment quite  considerably  by  omitting  to  consider  the  effect 
that  the  various  derangements  may  have  had  upon  the 
endocrine  functions  and  with  this  information  in  mind,  make 
a  concerted  effort  to  encourage  these  overworked  glands  and  ( 
favor  the  reestablishment  of  their  normal  functional  service 
to  the  body  in  conjunction  with  the  other  obvious  things 
we  need  to  do. 

There  are  other  causes  of  failure  with  organotherapy, 
which  will  occur  to  the  thinking  physician  and  which  need 
not  be  mentioned  here.  For  instance,  if  one  is  convinced 
that  a  certain  procedure  is  destined  to  fail,  likely  as  not  it 
will !  If  the  patient  is  sure  your  measures  are  not  going  to 
help,  the  psychic  condition  may  indeed  overbalance  a  large 
part  of  the  possible  benefit.  So  with  organotherapy.  We 
must  realize  that  it  is  but  a  factor  in  our  work  and  that  we 


THE  PLURIGLANDULAR  THEORY  31 

cannot  and  must  not  expect  the  administration  of  a  few 
tablets  or  capsules  to  reeducate,  rejuvenate  and  remake  our 
patients. 


SECTION  II.     CHAPTER  4 
"THE   PLURIGLANDULAR   THEORY" 


A  fundamental  principle  which,  to  my  way  of  thinking, 
has  broadened  organotherapy  in  a  very  decided  manner  is 
embodied  in  the  following  statement:  "Pluriglandular  dis- 
order is  much  more  frequent  than  disorders  involving  a 
single  gland  of  internal  secretion ;  hence  the  ree'nf orcement 
of  an  indicated  organotherapeutic  extract  with  one  or  more 
synergists  many  times  radically  alters  the  results  for  the 
better.  In  fact,  it  may  make  the  difference  between  success 
and  failure." 

It  is  not  difficult  to  understand  that  a  general  influence 
for  harm — toxic,  nutritional  or  emotional — hardly  can  be  ex- 
pected to  limit  its  effects  to  a  single  small  part  of  the 
organism.  A  severe  toxemia  such  as  we  find  in  pneumonia, 
typhoid  fever,  intestinal  stasis  or  poisoning  with  alcohol, 
morphin  or  other  drugs,  deranges  the  function  of  the  body 
as  a  whole  although  in  one  instance  a  certain  part  of  it, 
say  the  liver,  may  be  more  obviously  disordered  than  an- 
other. This  applies  equally  to  the  endocrine  glands,  and  the 
writer  frequently  has  said  with  emphasis  that  "there  never 
was  a  uniglandular  endocrine  disorder!"  This  may  seem 
to  be  a  rather  inclusive  statement;  but  it  would  be  difficult 
to  convince  me  of  the  reverse,  for  once  one  has  learned  the 
principles  underlying  hormone  action  and  the  extreme  in- 
timacy of  the  endocrine  glands  as  well  as  their  close  de- 
pendence the  one  upon  the  other,  it  is  not  easy  to  conceive  of 
any  obvious  or  hidden  disease  process  affecting  only  one 
or  two  of  these  remarkable  little  organs  to  the  exclusion 
of  the  others.  They  may  be  remotely  situated  from  one 
another,  but  they  are  very  closely  bound  together  by  their 
hormone  duties. 

Indeed,  students  of  the  subject  have  found  the  strands  of 
thought  closely  intertwined  and  practically  no  writer  on  the 
subject,  when  giving  consideration  to  one  special  gland,  has 
succeeded  in  omitting  to  refer  to  some  coincidental  influ- 
ence or  relation  between  that  gland  and  certain  others. 


32  PRACTICAL  ORGANOTHERAPY 

Clinical  Endocrine  Relations.  The  subject  is  so  important 
and  the  clinical  and  therapeutic  deductions  are  so  valuable 
that  it  may  be  well  to  give  some  more  attention  to  this 
"theory."  Take  as  an  example  a  fairly  common  ductless 
glandular  disorder — hypothyroidism.  It  is  seen  in  all  gra- 
dations, and  its  own  direct  manifestations  are  always  inter- 
twined with  those  of  other  origin.  No  case  of  myxedema  or 
cretinism,  or  even  of  the  less  marked  but  more  important 
minor  forms  of  thyroid  insufficiency,  shows  the  manifesta- 
tions of  thyroid  dysfunction  alone.  Metabolism  as  a  whole 
is  reduced — and  the  thyroid  is  not  the  only  endocrine  gland 
concerned  in  the  regulation  of  metabolism.  Gonad  func- 
tion is  disturbed,  and  in  cretins  it  practically  never  de- 
velops at  all. 

The  thyroid  gland  exerts  a  very  marked  cooperating  influ- 
ence upon  the  function  of  the  gonads,  and  perhaps  more 
so  in  the  case  of  the  ovaries  than  the  testes.  Thyroid  dis- 
order is  so  very  commonly  associated  with  menstrual  func- 
tions that  the  gynecologist  should  never  consider  a  case  of 
menstrual  derangement  without  also  considering  the  thyroid 
function  with  that  of  the  ovaries. 

I  might  say  in  passing,  that  the  idea  of  considering  the 
intimacy  of  the  thyroid  and  ovaries  came  to  me  as  I  was 
studying  in  Paris  a  number  of  years  ago  when  I  acci- 
dentally ran  across  some  information  which  seemed  inter- 
esting to  me  at  the  time,  but  has  grown  very  materially  in 
importance  since  then.  Paul  Dalche,  one  of  the  physicians 
at  the  famous  old  Hotel  Dieu,  routinely  ordered  a  combina- 
tion of  thyroid  with  ovarian  substance  in  all  ovarian  cases 
that  came  to  his  gynecological  dispensary  service  there — 
the  only  exception  to  this  routine  being  in  cases  obviously 
suffering  from  thyroid  irritability.  The  reason  for  this 
treatment  was  very  brief:  "The  thyroid  is  routinely  in- 
volved in  these  ovarian  cases." 

The  pituitary  gland,  likewise,  in  addition  to  its  large  in- 
fluence upon  the  metabolism,  exerts  a  stimulating  effect 
upon  the  sex  glands,  and  there  is  plenty  of  evidence  to  show 
that  the  pituitary  cooperates  with  the  thyroid  in  initiating 
and  maintaining  normal  sex  gland  activity.  A  casual  clin- 
ical experience,  which  the  student  of  endocrinology  often 
meets,  concerns  the  condition  known  as  pituitary  headache. 
In  many  women,  especially  where  there  is  an  ovarian  dys- 
function, during  the  period  just  prior  to  menstruation,  there 
is  a  very  serious  headache  of  the  splitting,  rending  variety. 
This  headache  usually  ends  at  the  establishment  of  menstru- 


THE  PLURIGLANDULAR  THEORY  33 

ation  and  is  not  noticed  until  the  corresponding  period  of 
the  next  month.  It  has  been  found  that  these  cases  benefit 
very  materially  by  pituitary  feeding,  and  a  logical  deduction 
in  regard  to  the  raison  d'etre  of  this  is  that  the  pituitary 
gland,  discovering  that  the  ovaries  are  not  working  as  nor- 
mally as  they  should,  becomes  functionally  hyperactive  and 
consequently,  engorged,  and  this  increase  in  its  size  (it  will 
be  remembered  that  the  pituitary  gland  lies  in  a  very  limited 
bony  space  called  the  sella  turcica)  causes  an  intracranial 
tension,  with  a  consequent  pressure  headache.  As  soon 
as  this  pituitary  engorgement  is  made  physiologically  un- 
necessary— either  by  the  regulation  of  the  ovarian  trouble 
or  the  replacement  of  a  part  of  the  missing  pituitary  prin- 
ciple by  organotherapy — we  relieve  the  cause  of  the  head- 
ache and  it  disappears  forthwith. 

The  adrenal  glands,  transcendently  important  in  those 
reactions  of  the  body  to  poisoning  and  emotional  circum- 
stances, influence  practically  all  of  the  ductless  glands 
through  their  motor  effects  upon  circulation.  When  the 
adrenals  are  stimulated,  muscular  and  circulatory  tone  is 
increased,  the  nutritional  exchanges  are  enhanced,  and  in 
general  there  is  an  acceleration  of  metabolism  and  all  cell- 
ular function.  Hyperadrenia  means  a  general  excitation 
of  the  sympathetic  system  and  endocrine  function  as  a 
whole.  On  the  other  hand,  unfortunately  the  adrenals  are 
very  easily  overstimulated  and  played  out,  with  the  result 
that  there  is  a  circulatory  stasis,  muscular  atonicity,  and 
general  asthenia  which  naturally  extends  to  the  other  duct- 
less glands,  bringing  about  not  merely  a  hypoadrenia,  but  a 
hypocrinism,  or  a  generalized  insufficiency  of  the  entire 
ductless  glandular  system. 

The  sympathetic  system,  which  we  have  every  reason  to 
believe  is  controlled  by  the  hormones  produced  in  the 
chromaffin  tissue  of  the  adrenal  glands,  is  very  decidedly 
affected  in  hypothyroidism,  and  in  the  well  marked  cases 
the  blood-pressure  is  low,  circulation  is  very  much  below  par, 
and  the  usual  sympathetic  reactions  are  dulled  or  even  lost. 

Again,  the  so-called  "compensatory  hypertrophy"  of  some 
glands  during  functional  or  organic  insufficiency  of  some 
other  intimately  associated  gland  of  internal  secretion  adds 
to  the  impression  that  these  organs  must  be  considered 
together  rather  than  separately.  The  cycle  of  the  develop- 
ment and  atrophy  of  the  mammary  glands  in  relation  to  the 
variations  of  the  ovarian  function  is  one  instance.  The  not 
infrequent  enlargement  of  the  thyroid  (and  more  rarely 


34  PRACTICAL  ORGANOTHERAPY 

the  pituitary)  during  the  period  of  normal  ovarian  inac- 
tivity— during  gestation  and  at  the  beginning  of  the  meno- 
pause; possibly  the  interstitial  glandular  hypertrophy  of 
the  prostate  when  the  testes  are  in  process  of  normal 
atrophy;  and  other  physiological  functional  dependencies 
which  we  do  not  need  to  mention,  all  tend  to  the  convic- 
tion that  we  must  no  longer  consider  endocrine  disease, 
functional  or  organic,  as  involving  the  gland  or  glands  alone 
which  most  obviously  are  affected. 

Synergistic  Organotherapy.  This  being  the  case  we 
should  be  able  to  make  good  use  of  the  principle  in  our  work, 
both  diagnostic  and  organotherapeutic ;  and  the  added  in- 
formation that  we  acquire  by  viewing  various  symptoms- 
complex  from  "the  pluriglandular  viewpoint"  is  just  as 
encouraging  as  the  better  results  that  we  get  from  pluri- 
glandular, as  compared  with  uniglandular,  endocrine 
preparations. 

Clinical  experience  has  established  this  beyond  all  doubt- 
literally  thousands  of  cases  of  obvious  dyscrinism,  having 
been  treated  with  single  endocrine  products  without  satis- 
factory results,  have,  on  changing  to  an  indicated  pluri- 
glandular remedy,  shown  results  as  different  as  they  are 
remarkable. 

In  brief,  then,  the  facts  warrant  the  combination  of  syner- 
gistic  gland  extracts  no  matter  whether  we  can  see  clear 
clinical  evidence  of  disorder  of  these  synergistic  glands. 
It  must  be  remembered  that  symptoms  do  not  necessarily 
manifest  themselves  for  quite  some  time  after  the  begin- 
nings of  actual  dysfunction  in  the  cells.  The  ovarian  side 
of  goitre,  or  the  thyroid  side  of  dysovarism,  does  not 
always  accompany  the  first  evidences  of  disturbed  secretion 
in  the  gland  originally  affected. 

Nor  must  we  limit  our  new  viewpoint  to  pairs  of  organs 
like  the  thyroid  and  the  gonads  just  referred  to.  In  hyper- 
thyroidism,  for  example,  not  only  may  we  find  deranged 
ovarian  function,  but  I  am  confident  that  not  a  few  of  the 
symptoms  of  sympathetic  irritability  are  not  so  much  due 
to  the  excess  of  thyroid  stuff  itself  as  to  the  undue  stimu- 
lation by  it  of  the  adrenal  glands.  Really  then  what  we  call 
hyperthyroidism  often  is  hyperadrenia  (!)  or  hypercrinism 
— a  generally  increased  endocrine  activity  due  to  a  con- 
dition which  has  increased  thyroid  secretion  beyond  all 
reasonable  bounds  and  consequently  simultaneously  has 
stimulated  the  pituitary,  adrenals,  gonads  and  other  endo- 
crine glands.  If  this  is  the  case,  medication  to  be  success- 


THE  PLURIGLANDULAR  THEORY  35 

ful  should  take  the  whole  endocrine  system  into  considera- 
tion and  not  the  offending  thyroid  alone.  The  same  applies 
even  more  to  conditions  of  hypocrinism  which  result  from 
pluriglandular  insufficiency. 

Antagonistic  Organotherapy.  Another  interesting  aspect 
to  this  study  is  the  antagonism  which  may  be  exerted 
between  glands  of  internal  secretion.  The  islands  of  Langer- 
hans  in  the  pancreas  are  known  to  have  a  large  part  in  the 
regulation  of  the  metabolism  of  carbohydrates  and,  inci- 
dentally, to  exert  an  opposing  influence  upon  the  adrenals. 
This  is  so  well-defined  in  the  experimental  work  that  has 
been  done  along  these  lines  that  a  new  classification  of  in- 
ternal secretory  principles  has  been  demanded  merely  be- 
cause the  word  "hormone"  means  "I  arouse"  or  "set  in  mo- 
tion," and  the  chief  function  of  the  hormone  from  the 
islands  of  Langerhans  is  to  prevent  too  much  "motion"  on 
the  part  of  the  adrenal  glands.  The  French  call  this  Langer- 
hansian  principle  an  "anti-hormone,"  and  von  Noorden  has 
called  it  "the  brake  to  the  sugar  mechanism"  merely  be- 
cause it  prevents  an  overoxidation  of  sugars  and  restrains 
adrenal  activity. 

This  particular  principle  is  used  in  organotherapy  to 
control  overirritability  of  the  adrenal  glands,  to  lessen  the 
condition  known  as  "sympatheticotonus",  to  reduce  the  im- 
balance in  hyperthyroidism,  and  also  in  diabetes  mellitus. 

Another  and  equally  remarkable  hormone  antagonism 
concerns  the  influence  that  the  mammary  glands  exert  upon 
ovarian  function.  The  mammae  undoubtedly  have  a  dual 
function,  and  in  addition  to  their  galactogenous  influence 
they  undoubtedly  oppose  ovarian  activity.  The  physiology 
of  mammary  growth  and  function  tends  to  supplement  this 
impression,  but  our  best  information  comes  from  the  use  of 
mammary  therapy  in  conditions  of  ovarian  irritability,  and 
particularly  menorrhagia.  It  has  been  found  repeatedly 
that  mammary  therapy  is  a  well-conceived  anti-ovarian 
remedy,  and  for  this  reason  the  internal  secretory  principle 
believed  to  be  present  in  the  mammary  tissue,  has  been 
called,  like  the  pancreas  principle,  an  anti-hormone. 

Nothing  has  been  said  about  the  parathyroids,  pineal, 
the  carotid  glands  and  certain  other  secretory  organs  like 
the  liver,  the  duodenum,  etc.,  which  have  an  internal  as 
well  as  an  external  secretion.  Suffice  it  to  say  that  all  form 
a  part  of  a  large,  well-ordered  and  complex  mechanism 
which  deserves  consideration  as  a  whole  whenever  any  one 
part  of  it  is  deranged. 


36  PRACTICAL  ORGANOTHERAPY 

Combinations  Superior  to  Single  Extracts.  This  all  ex- 
plains why  combinations  of  various  endocrine  preparations 
so  often  excel  single  extracts.  In  previous  communications, 
and  in  both  of  my  books  referred  to  elsewhere,  I  have 
strongly  urged  the  combination  of  suited  products  of  this 
kind.  The  profession  is  thoroughly  converted  to  moderate 
polypharmacy,  and  we  combine  our  A.  B.  &  S.,  or  our  I.  Q. 
&  S.,  our  mercury  and  potassium  iodide,  or  many  other  well- 
known  pharmaceutical  products.  Rarely  is  a  prescription 
written  for  a  single  remedy,  for  we  are  absolutely  convinced 
that  synergism  is  possible  in  pharmacology  just  as  it  is  in 
physiology.  Should  there,  then,  be  any  real  basis  for  criti- 
cism of  pluriglandular  therapy  by  those  who  routinely  apply 
the  same  principles  in  polypharmacy,  especially  when  we 
recall  that  the  blood  itself  contains  in  solution  a  host  of 
differing  chemical  substances,  some  synergistic  and  some 
antagonistic  ? 

As  a  matter  of  fact,  such  portions  of  a  pluriglandular  mix- 
ture given  per  os  as  are  absorbed  in  the  blood,  merely  am- 
plify the  sum  total  of  hormones  circulating  in  the  blood 
according  to  the  principle  of  homostimulation  already  out- 
lined, and  arouse  to  increased  functional  action  those  organs 
whose  work  it  is  to  produce  hormones  similar  to  those  which 
have  been  administered.  Thus  hypocrinism  is  reduced  and 
the  aggregate  of  hormone  stimuli  is  increased. 

Certain  aspects  of  the  correlation  of  the  glands  will  be 
referred  to  in  later  chapters  when  particular  syndromes  are 
being  given  consideration  from  the  clinical  standpoint.  It 
seemed  advisable  to  include  these  brief  hints  here  merely 
because  so  many  physicians  are  at  sea  when  they  come  to 
consider  the  actual  relationship  that  these  glands  bear  to 
one  another. 


SECTION  II.    CHAPTER  5 
A  HYPOTHESIS  OF  "HORMONE  HUNGER' 


The  following  remarks  originally  constituted  a  communi- 
cation which  was  published  in  the  New  York  Medical  Record 
(August  16,  1919).  I  am  pleased  to  state  that  it  aroused 
considerable  favorable  comment  and,  by  many  physicians, 
has  been  accepted  as  a  reasonable  explanation  of  what  really 
happens  in  the  cells  which  depend  upon  hormone  stimuli. 


A  HYPOTHESIS  OF  HORMONE  HUNGER  37 

Certain  fundamentals  in  medicine  as  in  other  sciences 
necessarily  must  be  based  upon  hypotheses,  for  it  is  not 
accorded  to  man  to  know  all  about  the  Creator's  work.  We 
are  confident  that  scarlet  fever,  measles  and  even  "flu"  are 
of  bacterial  origin;  but  we  have  yet  to  isolate  and  identify 
the  offending  organisms,  as  we  have  done,  for  instance, 
with  the  typhoid  bacillus.  Again  the  "accepted  explanation" 
of  the  processes  of  immunity  is  the  so-called  "side  chain 
theory"  propounded  by  Ehrlich ;  and  today  this  hypothesis 
is  as  far  as  we  can  go  in  giving  a  reason  for  the  "immuniz- 
ing response"  of  the  body  and  the  "how"  of  its  resistance 
to  bacterial  invasion. 

The  clinician  has  to  presume  many  times.  Facts  are  not 
always  so  easy  to  secure.  On  the  other  hand,  the  physiolo- 
gist hesitates  to  presume — he  must  be  scientific  and  em- 
piricism has  no  place  with  him.  Despite  this  it  happens  that 
neither  clinician  nor  physiologist  really  understands  how  the 
hormones  of  the  glands  of  internal  secretion  are  made  and 
used.  We  have  satisfactorily  proved  their  existence  and 
that  many  of  them  are  definite  chemical  entities,  some  of 
which  already  have  been  isolated  in  crystalline  form.  We 
are  certain  that  they  are  secreted  into  the  blood  or  body 
fluids  and  thus  carried  to  distant  organs  or  cells  to  "corre- 
late the  activities  of  the  organ  of  origin  with  the  remote 
but  associated  organ  that  it  influences." 

How  these  hormones  are  carried,  whether  they  are  pro- 
duced in  the  same  form  that  they  are  used*  and  exactly 
how  they  reach  the  cells  which  they  are  destined  to  "arouse, 
or  set  in  motion,"  is  not  known.  A  hypothesis  is  in  order. 

For  a  number  of  years  I  have  been  studying  this  sub- 
ject and  not  a  few  clinical  experiences  with  various  forms 
of  organotherapy  in  certain  endocrine  disturbances  have 
convinced  me  that  there  are  varying  degrees  of  receptive- 
ness  to  hormone  stimuli  on  the  part  of  various  individuals. 
In  other  words,  where  in  one  instance  a  very  rapid  and  re- 
markable result  may  be  secured,  in  another  seemingly  sim- 
ilar case  the  reactivity  of  the  patient  differs  and  the  results 
are  not  so  good  or  so  rapid.  This  has  caused  me  to  ponder 
on  the  subject  and  I  have  evolved  what  I  have  chosen  to  call 
"a  hypothesis  of  hormone  hunger." 


*  In  1913  I  had  the  opportunity  of  doing  some  interesting  work  with 
Hustin  in  the  Institut  Pare  Leopold,  Brussels.  He  showed  that  secre- 
tin  activated  the  secretory  cells  of  a  pancreas  separated  from  the 
body — in  a  paraffin  bath;  but  the  most  active  secretin  solution  had  to 
be  mixed  with  blood  before  it  would  do  the  work. 


38  PRACTICAL   ORGANOTHERAPY 

Selecting  the  Hormones  from  the  Blood.  Each  organ  of 
the  body  that  is  dependent  upon  hormone  influences  must 
have  some  subtle  capacity  to  pick  up  the  hormones  from  the 
blood  as  they  float  by.  This  cannot  but  be  true,  else  how 
could  the  passing  "chemical  messengers"  bring  about  the 
influence  upon  the  organ  or  cell  that  they  are  supposed  to 
affect?  Not  only  must  there  be  a  definite  capacity  to  pick 
up  these  hormones  as  they  are  brought  to  the  cell  by  the 
blood,  but  there  must  be  a  selective  capacity,  for  the  blood 
contains  all  the  hormones  that  we  know  of  as  well  as  prob- 
ably a  good  many  more  that  we  do  not  know  at  present.  I 
do  not  feel  that  the  imagination  has  to  be  stretched  very 
much  to  presume  that  there  is  a  remarkable  "cellular  judg- 
ment" or  selective  capacity  to  pick  out  the  hormones  that 
are  needed — and  in  the  amount  that  they  are  needed. 

It  is  with  this  particular  selective  power  of  mind  that  I 
have  developed  this  hypothesis  of  hormone  hunger.  I  con- 
tend that  under  varying  circumstances  these  cells  must  be 
more  active  in  their  picking  up  of  the  passing  hormones 
than  at  other  times.  In  other  words,  at  times  a  condition 
of  hormone  hunger  actually  must  be  present.  Let  me  ex- 
plain: Take  as  an  example  the  thyro-ovarian  interrelation- 
ship— this  is,  perhaps,  the  most  thoroughly  established  and 
most  easily  understood.  It  is  well  known  that  there  is  a 
principle  produced  in  the  thyroid  gland  which  exerts  a  very 
marked  influence  upon  ovarian  function.  (It  will  be  recalled 
that  in  myxedema  there  are  definite  functional  ovarian 
disorders,  that  girls  with  goitre  very  often  have  serious 
menstrual  difficulties  and,  finally,  that  the  cretin,  who  has 
no  thyroid  gland,  does  not  develop  sexually.)  Surely  it  is 
fair  to  believe  that  there  is  a  principle  made  in  the  thyroid 
which  stimulates  ovarian  function,  and  that  this  must  neces- 
sarily reach  the  ovaries  through  the  blood,  and,  of  course, 
that  the  ovaries  must  have  some  means  of  getting  hold  of 
this  hormone.  If,  then,  this  thyroid  hormone  passing 
through  the  ovaries  in  its  blood  supply  happens  to  be  de- 
ficient, after  as  much  of  it  as  can  be  found  is  taken  up  by 
the  cells  of  the  ovary,  and  the  demand  is  greater  than  the 
supply,  there  will  remain  a  need  for  that  which  is  not  pres- 
ent, i.  e.,  the  ovarian  cells  will  be  "hungry"  for  more  of  the 
thyroid  stimulus.  Further  this  "hunger"  will  vary,  depend- 
ing upon  the  degree  to  which  the  thyroid  is  functioning 
and  the  hormone  needs  of  the  ovary. 

A  Case  in  Point.  In  a  case  with  well  defined  hypothyroid- 
ism  it  is  reasonable  to  suppose  that  the  ovarian  cells  are 


A  HYPOTHESIS  OF  HORMONE  HUNGER  39 

getting  along  as  best  they  can  with  little  or  none  of  their 
usual  stimuli  (and  right  here  enters  the  fascinating  study 
of  the  effects  of  hormone  hunger  upon  other  endocrine 
glands — how  the  pituitary,  for  instance,  may  function  faster 
to  make  up  for  deficiencies  in  its  associates,  etc.)  If  we 
attempt  to  modify  the  clinical  disturbances  which  result 
from  this  hormone  insufficiency  by  means  of  organotherapy, 
the  application  of  this  hypothesis  enables  us  to  appreciate 
that  the  "hormone  hunger"  of  these  ovarian  cells  increases 
their  presumed  "urge"  to  pick  out  from  the  circulation  such 
additional  hormones  as  we  may  be  able  to  give  by  mouth 
(and  incidentally  to  benefit  from  the  enhanced  hormone  pro- 
duction which  follows  organotherapy,  upon  the  principle  of 
"homostimulation"  as  outlined  in  Hallion's  law*)  and  to 
understand  that  this  selective  capacity  will  be  the  greater  in 
proportion  to  the  cellular  need  for  the  accustomed  hormones 
which  happen  to  be  deficient. 

To  put  this  in  another  way:  If  we  give  thyroid  extract 
as  a  therapeutic  measure  in  dysovarism,  the  ovaries  are  un- 
usually interested  in  securing  the  thyroid  hormone  which 
may  get  into  the  blood,  and  they  will  select  it  with  greater 
avidity,  depending  upon  the  degree  of  "hormone  hunger" 
that  may  be  present ;  and  as  soon  as  the  necessities  of  these 
glands  have  been  satisfied  the  unusual  facility  with  which 
the  hormones  are  picked  out  from  the  blood  stream  will 
cease,  and  we  presume  that  superfluous  amounts  of  any  or 
all  of  the  hormones  will  remain  in  the  blood  either  until 
they  are  used  later  on  by  any  organs  that  may  be  able  to 
avail  themselves  of  their  stimuli,  or  are  finally  oxidized. 

There  is  another  phase  of  this  matter  which  appears  to 
me  to  be  of  importance,  and  which  I  think  is  more  satisfac- 
torily explained  by  this  hypothesis  than  in  any  other  way. 
We  are  convinced  that  the  intimate  interrelationships  of 
the  glands  of  internal  secretion  practically  eliminate  the  pos- 
sibility of  endocrine  disturbances  involving  a  single  endo- 
crine gland.  That  is  to  say,  when  there  is  a  disturbance  of 
one  internal  secretory  organ,  immediately  there  develops  an 
associated  functional  derangement  of  the  hormone  balance, 


*  The  "law"  propounded  by  Hallion  (Presse  Medicate,  1912,  xx,  433), 
explains  the  principle  named  "homostimulation."  It  is  as  follows: 
"Extracts  of  an  organ  exert  on  the  same  organ  an  exciting  influence 
which  lasts  for  a  longer  or  shorter  time*.  When  the  organ  is  insuf- 
ficient, it  is  conceivable  that  this  influence  augments  its  action,  and, 
when  it  is  injured,  that  it  favors  its  restoration."  (Translation  made 
in  my  book  "Practical  Hormone  Therapy,"  p.  24.) 


40  PRACTICAL   ORGANOTHERAPY 

involving  one  or  more  of  the  glands  most  intimately  de- 
pendent upon  the  originally  affected  gland.  Hence  pluri- 
glandular  disturbances  are  the  rule,  and  therefore  pluri- 
glandular therapy  must  take  the  place  of  the  old-fashioned 
administration  of  the  most  obviously  needed  glandular  ex- 
tract. As  yet  this  position  is  not  generally  accepted,  and 
some  members  of  the  profession  still  assert  that  this  is 
"shot-gun  therapeutics."  Others,  whose  clinical  experience 
and  viewpoint  are  broader,  now  insist  that  in  the  combining 
of  various  related  glandular  products  we  are  finding  much 
greater  clinical  satisfaction — and  the  "crucible  of  the  clinic," 
as  George  W.  Crile  calls  it,  is  the  only  real  test  of  any  new 
or  modified  therapeutic  measure.  In  passing,  take  as  an 
instance  the  cretin,  who  it  is  well  known  is  in  dire  need  of 
the  physiological  stimulation  resulting  from  the  thyroid 
hormones.  Many  times  a  cretin  develops  remarkably  on 
thyroid  alone,  and  then  reaches  a  seeming  barrier  beyond 
which  no  progress  is  made.  If,  then,  the  associated  glands, 
especially  the  anterior  pituitary  is  given  with  the  thyroid, 
the  progress  is  reestablished  and  sometimes  far  excels  that 
previously  made.  This  also  applies  with  equal  force  in  many 
other  pluriglandular  dystrophies,  the  most  common  of  which 
is  the  thyro-ovarian  dysfunction  already  mentioned. 

An  Explanation  of  Pluriglandular  Therapy.  This  brings 
me  to  my  final  point:  This  hypothesis  of  hormone  hunger 
explains  the  "how"  of  pluriglandular  therapy.  Many  times 
I  have  wished  that  it  were  possible  to  determine  the  degree 
of  glandular  insufficiency  in  a  given  individual,  just  as  we 
can  estimate  the  urinary  solids  and  differentiate  the  per- 
centage of  urea,  chlorides,  phosphates,  etc.,  in  figures,  or 
as  we  do  in  the  differential  blood  count.  It  would  be  ideal 
to  be  able  to  establish  that,  for  example,  a  given  case  is 
50%  low  on  thyroid,  75%  low  on  ovarian,  and  20%  low  on 
pituitary  hormone  functioning.  Obviously  this  would  fa- 
cilitate a  fairly  definite  therapeutic  recommendation ;  but  we 
cannot  do  this,  although  my  Thyroid  Function  Test  (see 
Medical  Record,  August  3, 1918)  is  quite  a  step  in  this  direc- 
tion in  the  study  of  one  of  these  dyscrinisms. 

How,  then,  can  we  treat  these  cases  scientifically?  We 
cannot;  but  by  depending  upon  the  hypothetical  principle 
of  "hormone  hunger"  just  enunciated  we  can  offer  a  pluri- 
glandular mixture  and  allow  the  body  to  do  its  own  select- 
ing. We  can  trust  the  organism  to  pick  out  from  the  menu 
we  offer  it  those  hormones  that  it  needs  most  and,  too,  in 
the  degree  that  it  needs  them.  Then,  based  upon  the  pre- 


A  HYPOTHESIS  OF  HORMONE  HUNGER  41 

viously  mentioned  condition  which  might  be  called  "hor- 
mone satiety,"  the  limited  excess  of  unused  hormones  floats 
on  until  used  up  or  destroyed.  This  explains  to  me  the  rea- 
son for  the  clinical  experience  many  of  us  may  have  had 
•with  the  same  pluriglandular  therapy  in  several  somewhat 
dissimilar  cases:  In  one  case  a  thyroid  influence  predomi- 
nates, in  another  a  pituitary  and  the  third  an  ovarian,  all 
because  in  these  three  instances  the  hormone  hunger  made 
it  possible  to  grab  the  various  respective  hormones  with  a 
greater  avidity  and  rapidity. 

Whether  this  hypothesis  is  as  well  founded  as  the  Ehrlich 
"side  chain  theory"  of  immunity,  is  not  for  me  to  say.  It 
explains  many  things  that  I  have  seen  repeatedly  in  clin- 
ical organotherapy  and  I  believe  it  is  based  on  sound  reason- 
ing and  worthy  of  consideration.  At  all  events  this  re- 
markable selective  capacity  of  the  hormone-influenced  or- 
gans or  cells  is  something  that  cannot  be  gainsaid;  and  the 
clinical  results  are  certain  enough  whether  the  hypothesis 
is  well-grounded  or  not. 

Since  the  original  publication  of  the  foregoing  chapter  in 
the  New  York  Medical  Record  (August  16,  1919),  many 
references  have  been  made  in  various  periodicals  to  this 
hypothesis.  The  following  editorial,  which  appeared  in  the 
Medical  Review  of  Reviews  (New  York,  Jan.,  1920)  is 
being  reprinted  despite  certain  unavoidable  repetitions: 

"  'A  Hypothesis  of  Hormone  Hunger.'  Henry  R.  Har- 
rower,  of  Los  Angeles,  in  the  New  York  Medical  Record 
for  August  16,  1919,  sets  forward  a  theory  in  regard  to 
the  manner  in  which  the  glands  of  internal  secretion  respond 
to  the  various  hormone  stimuli  and  to  a  condition  called 
'hormone  hunger/  which  may  explain  some  matters  per- 
taining to  endocrinology,  and  especially  the  administration 
of  gland  combinations  in  pluriglandular  dystrophies. 

"Harrower  presumes  that  there  must  be  some  facility 
on  the  part  of  the  various  glands  which  are  stimulated  by 
hormones  from  other  internal  secretory  organs  to  pick  out 
these  various  substances  from  the  blood  as  it  passes  through 
them,  and  suggests  that  if  the  supply  of  the  stimulating 
substances  is  lessened  there  will  naturally  ensue  a  condition 
of  hormone  hunger  or  insufficiency  as  a  result  of  the 
deficient  supply  of  the  stimulating  substances.  Naturally 
this  condition  of  hormone  hunger  would  be  dependent  upon 
(1)  the  necessities  of  the  gland  that  is  to  be  stimulated, 
and  (2)  the  deficiency  of  the  stimulating  substance  pro- 
duced elsewhere. 


42  PRACTICAL   ORGANOTHERAPY 

"There  seems  to  be  no  way  of  proving  this  matter  defi- 
nitely, but  since  one  of  the  greatest  factors  in  therapeutics 
is  dependent  upon  a  theory — the  principles  of  immunity  are 
based  exclusively  upon  a  theory  suggested  a  number  of 
years  ago  by  Ehrlich — it  may  not  be  out  of  the  way  to 
presume  some  in  this  matter  also.  Attention  is  called  to  the 
relationship  between  the  thyroid  gland  and  the  ovary.  It 
is  well  known  that  these  glands  exert  a  reciprocal  action 
upon  one  another,  each  being  stimulated  by  the  other,  and 
vice  versa.  If,  then,  there  is  a  condition  of  thyroid  insuffi- 
ciency there  will  naturally  be  a  deficient  activity  on  the 
part  of  the  ovaries  manifested  by  such  symptoms  as 
amenorrhea,  dysmenorrhea  and  the  numerous  neuroses  con- 
nected with  menstrual  disturbances  and  the  menopause, 
and  at  the  same  time  a  condition  of  unusual  need  by  the 
ovary  for  the  stimuli  will  obtain.  This  is  what  Harrower 
calls  'hormone  hunger,'  and  he  believes  that  the  degree  of 
desire  or  necessity  for  these  various  hormones  on  the  part 
of  the  gland  that  is  to  be  stimulated  must  vary  with  the 
supply  of  the  hormones  that  can  be  found  in  the  blood. 

'The  practical  application  of  this  idea  concerns  the  ad- 
ministration of  combinations  of  glands  in  presumed  pluri- 
glandular  disturbances.  If,  for  instance,  in  the  conditions 
mentioned  above  there  is  a  noticeable  deficiency  in  several 
of  the  glands  of  internal  secretion,  the  thyroid,  ovaries  and 
pituitary  gland  for  instance,  there  may  be  varying  degrees 
of  hormone  hunger  on  the  part  of  the  organs  involved, 
and  this  will  influence  very  definitely  the  amount  of  hor- 
mones that  may  be  missing  or  needed  by  the  glands  to  be 
stimulated.  In  such  a  pluriglandular  disturbance,  if  the 
thyroid  element  were  greater  than  the  ovarian  element,  the 
avidity  with  which  the  thyroid  part  of  a  pluriglandular 
formula  was  used  would  be  dependent  upon  the  degree  of 
hormone  hunger  on  the  part  of  the  thyroid  gland,  and  if 
any  other  gland  was  in  greater  need  proportionately  its 
capacity  to  pick  out  the  hormones  from  the  blood  would  be 
sharpened  so  much  the  more.  In  other  words,  the  greater 
the  hormone  need,  or  'hormone  hunger/  the  greater  the 
capacity  to  select  from  what  may  be  given  to  it  in  the  way 
of  organotherapy. 

"This  hypothesis  seems  to  be  based  upon  sound  reasoning, 
and  explains  quite  a  number  of  things  in  regard  to  organo- 
therapy, and  especially  the  varying  reaction  to  the  same 
pluriglandular  formula  in  different  cases.  For  instance, 
in  a  case  of  amenorrhea,  due  to  a  pituitary  dystrophy,  the 


A  HYPOTHESIS  OF  HORMONE  HUNGER  43 

pituitary  element  would  be  accepted  more  quickly  than 
the  other  elements  in  the  formula,  while  if  the  ovarian 
element  predominated  this  factor  would  be  both  quickly 
and  thoroughly  used  up.  It  is  then  presumed  that  any 
product  of  an  endocrine  character  that  may  be  given  in  a 
pluriglandular  formula  that  may  not  be  actually  needed 
immediately  would  be  allowed  to  pass  around  in  the  blood 
until  the  necessary  hormone  hunger  was  aroused,  or  until 
finally  oxidized." 

Some  Criticisms  of  Harrower's  Hypothesis.  The  chief 
criticism  of  this  hypothesis  seems  to  be  based  upon  the 
opinion  that  excesses  of  a  given  hormone  are  not  neces- 
sarily allowed  to  pass  by,  as  I  suggest.  For  instance,  in  a 
personal  communication,  Dr.  Solomon  Solis  Cohen,  of  Phila- 
delphia, writes:  "I  have  no  doubt  whatever  that  various 
tissues  exercise  a  selective  action  on  substances  circulating 
in  the  blood,  otherwise  there  would  be  no  physiology  or 
pharmacology  to  study.  Also  there  is  such  a  thing  as  satu- 
ration of  tissue  so  that  it  will  not  take  up  any  more  of  a 
certain  substance;  but  whether  we  can  lay  down  an  abso- 
lute rule  that  tissues  needing  a  definite  hormone  will  take 
up  ...  just  the  amount  of  that  hormone  which  they 
need,  and  no  more  and  no  less,  is  another  matter.  .  .  . 
In  exophthalmic  goitre,  for  example,  in  which  an  excess  of 
thyroid  function  is  observed,  certain  tissues  at  least  take 
up  more  of  thyroid  hormone  than  they  need.  (I  do  not, 
and  never  have,  looked  upon  Graves'  disorder  as  primarily 
a  thyroid  disturbance;  the  thyroid  excess  is  part  of  it.) 

"According  to  your  theory,  the  excess  of  thyroid  should 
be  carried  out  of  .the  body  or  destroyed  without  creating 
any  disturbance,  but  it  is  not.  ...  I  am  not  drawing 
any  conclusions;  I  am  merely  pointing  out  the  necessity 
for  realizing  the  limitations  of  our  knowledge.  Every  earn- 
est attempt  to  throw  light  into  the  darkness,  whether  by 
hypothesis  or  experiment,  should  be  welcomed." 

Dr.  Solis  Cohen  is  not  the  only  one  to  criticize  this 
particular  point  in  my  hypothesis.  For  instance,  in 
American  Medicine  (September,  1921),  James  C.  Wood,  of 
Cleveland,  Ohio,  discussing  the  practical  application  of  or- 
ganotherapy, remarks:  "It  seems  to  the  writer  that  the 
weak  point  in  Harrower's  hypothesis,  upon  which  pluri- 
glandular therapy  is  based,  is  that,  while  it  may  apply  to 
fairly  normal  individuals,  it  most  emphatically  does  not 
apply  to  those  cases  where  there  is  hyperfunction  of  certain 
of  the  endocrine  glands.  One  does  not  have  to  get  very  far 


44  PRACTICAL  ORGANOTHERAPY 

in  his  clinical  observation  to  learn,  for  instance,  that  in 
hyperadrenia  and  hyperthyroidism,  even  very  small  doses  of 
adrenal  or  thyroid  will  aggravate  the  symptoms.  .  .  ." 

Still  another  criticism  comes  to  my  attention  as  this 
Section  is  being  completed.  R.  G.  Hoskins,  editor  of  Endo- 
crinology, in  a  signed  editorial  entitled  "What  Is  Endo- 
crinology?" (Endocrinology,  September,  1921,  p.  610),  after 
having  dubbed  me  a  "pseudoendocrinologist"  and  generally 
belittled  my  efforts,  says:  "The  'remarkable  selective 
capacity  of  the  organism'  [quoting  from  me — H.  R.  H.]  is, 
so  far  as  can  now  be  determined,  a  mere  figment  of  the 
imagination,  which  is  being  grossly  overworked  as  an  excuse 
for  haphazard,  pluriglandular  dosing.  If  the  body  cells 
were  possessed  of  any  such  critical  acumen  as  postulated, 
why  should  we  ever  encounter  a  case  of  acromegaly  or  hy- 
perthyroidism? It  is  definitely  proved  that  the  cells  will 
take  up  thyroxin  or  epinephrin  in  lethal  quantities,  when 
exposed  to  excess  of  these  substances." 

Now  to  discuss  the  last  remark  first:  It  is  quite  interest- 
ing to  note  that  so  prominent  a  writer  as  Solomon  Solis 
Cohen,  already  quoted  above,  does  not  believe  that  this  is 
quite  so  imaginary,  and  would  you  believe  it,  this  very 
editor — R.  G.  Hoskins,  of  Columbus,  Ohio — in  commenting 
upon  my  original  reprint  sent  to  him  toward  the  close  of 
1919  (the  paper  was  published  in  the  New  York  Medical 
Record,  August  16,  1919)  was  good  enough  to  write  to  me: 
"Thank  you  for  your  interesting  reprint  of  your  'Hormone 
Hunger'  paper.  So  far  as  I  can  see,  it  is  perfectly  good 
biology;  it  is  rather  demonstrated  fact,  however,  than 
theory.  You  are  somewhat  too  modest  in  applying  it  merely 
to  hormones.  Precisely  the  same  mechanism — whatever  it 
may  be — comes  into  play  when  a  young  bone  cell  has  to  pick 
out  calcium  or  an  active  muscle,  glucose,  from  the  blood. 
One  can  call  it  'hunger/  'specific  affinity'  or  whatnot.  Your 
term  has  the  advantage  of  graphicness."* 

Every  theory  has  large  opportunities  for  error  to  be 
woven  in  with  it ;  otherwise,  it  would  not  be  a  theory  but  a 
fact.  That  I  am  aware  of  this  is  evident  by  the  fact  that  I 
have  called  this  a  hypothesis  of  hormone  hunger,  and  de- 
spite the  reasonableness  of  the  attitude  of  both  Doctors 
Solis  Cohen  and  Wood,  they  are  not  belittling  the  hormone 


*  From  a  personal  communication  received  late  in  1919,  and  shortly 
after  its  receipt,  published  in  The  Organotherapeutic  Review,  January 
1920,  p.  62. 


45 

hunger  side  of  this  matter  so  much  as  "hormone  satiety," 
as  I  have  called  it. 

However,  we  are  not  offering  "lethal  quantities"  of  any 
of  these  products;  we  are  not  discussing  for  the  moment 
conditions  of  hypercrinism  such  as  the  hyperadrenia  and 
hyperthyroidism  referred  to,  we  are  talking  about  the  ca- 
pacity of  the  body  to  utilize  certain  hormones  when  it  is 
presumed  by  the  symptoms  that  these  hormones  are  de- 
ficient; and  I  repeat  that  clinical  experience  shows  that  in 
these  persons  the  avidity  with  which  the  previously  missing 
and  artificially  replaced  substances  are  taken  up,  indicates 
that  there  must  be  some  sort  of  a  "hunger"  as  I  call  it,  to 
facilitate  their  appropriation.  As  to  whether  an  excess  is 
indeed  permitted  to  remain  in  the  circulation  until  oxidized 
or  eliminated,  is  another  matter,  and  just  because  we  can- 
not be  assured  of  this  we  should  not  cast  the  whole  theory 
into  the  discard. 

The  fact  remains  that  there  are  varying  degrees  of  inter- 
est on  the  part  of  the  various  cells  of  the  body  for  certain 
hormones  that  we  may  offer  to  them,  and  provided  we  are 
reasonable  in  the  extent  and  character  of  our  menus,  we 
are  going  to  accomplish  a  great  many  remarkable  things 
with  our  "haphazard  pluriglandular  dosing"  and  the  "im- 
pressionistic physiology"  upon  which  it  is  based! 


SECTION  II.    CHAPTER  6 
DIAGNOSTIC  ORGANOTHERAPY 


One  of  the  most  interesting  things  about  the  adminis- 
tration of  glandular  extracts  is  the  fact  that  we  can  learn 
in  many  instances,  by  the  responsiveness  of  the  patient  to 
the  product,  points  which  are  often  of  great  diagnostic 
value. 

As  the  student  of  endocrinology  begins  to  look  for  cer- 
tain clinical  and  laboratory  findings  to  serve  him  as  guides 
to  the  presence  and  character  of  certain  endocrine  disturb- 
ances, for  absolute,  infallible  information  he  finds  him- 
self depending  very  largely  upon  the  response  of  the  indi- 
vidual to  his  treatment. 

Clinical  Diagnostic  Therapeutics.  My  Thyroid  Function 
Test,  which  is  mentioned  elsewhere  in  this  book  and  which 
was  developed  from  many  clinical  experiences  with  thyroid 


46  PRACTICAL  ORGANOTHERAPY 

therapy,  some  of  which  did  not  have  altogether  pleasant 
results,  is  an  indicator  of  thyroid  apathy  or  sensitiveness, 
as  the  case  may  be.  In  quite  a  number  of  cases,  as  a  result 
of  this  test,  the  thyroid  condition  which  it  was  desired  to 
study  has  been  ameliorated  very  much,  or  even  has  disap- 
peared entirely  during  the  test,  and  we  were  forced  to  con- 
clude that  the  administration  of  the  limited  amount  of  thy- 
roid given  in  the  routine  manner  in  order  to  secure  the  pulse 
chart  expected  in  this  test,  was  sufficient  radically  to  change 
the  conditions  present.  This  in  itself  serves  to  prove  to  us 
that  there  was  indeed  a  decided  thyroid  aspect  to  the  case 
and  that  even  the  beginning  of  an  indicated  therapy  suf- 
ficed to  bring  clinical  changes  in  it,  and  consequently,  proved 
its  worth. 

As  we  know,  a  great  many  circulatory,  nervous  and  men- 
tal states  frequently  are  related  to  disturbances  of  the  ova- 
rian function.  At  puberty,  in  connection  with  certain  men- 
strual difficulties,  and  at  the  change  of  life,  many  an  obscure 
symptom  is  discovered  that  cannot  always  be  traced  to  a 
definite  cause.  Usually  these  symptoms  are  related  to  more 
or  less  prominent  endocrine  manifestations,  and  in  the  in- 
stance under  discussion  there  is  a  change  in  the  menses  or 
associated  manifestations.  In  many  hundreds  of  cases,  for 
lack  of  better  knowledge  and  a  more  satisfactory  procedure, 
it  has  been  presumed  that  this  or  that  difficulty  might  be 
related  to  the  imbalance  resulting  from  the  disturbed  ova- 
rian function,  and,  on  treating  this  presumed  dysovarism, 
many  times  the  resulting  nervous,  circulatory  or  mental 
condition  has  been  benefited  simultaneously.  This  has  hap- 
pened far  too  many  times  to  be  considered  as  coincidental, 
and  many  physicians  have  come  to  the  conclusion  that  they 
may  recommend  organotherapy  in  cases  of  this  kind  with 
the  expectation  of  acquiring  diagnostic  information  of  con- 
siderable value,  in  addition  to  the  hoped-for  therapeutic 
results. 

If  such  an  individual  secures  benefit  from  the  organo- 
therapy, in  the  realms  controlled  by  the  endocrine  disturb- 
ance, and  the  benefit  is  extended  to  other  physiological  func- 
tions, which  may  or  may  not  be  related  to  those  of  the 
endocrines,  and  such  experiences  are  repeated  time  and 
again,  one  very  naturally  comes  to  the  conclusion  that  the 
organotherapy  not  merely  rendered  therapeutic  service  in 
suitable  cases,  bid  also  a  diagnostic  service,  the  extent  of 
which,  and  the  value  to  the  investigator,  cannot  very  well 
be  predicted  in  advance. 


DIAGNOSTIC  ORGANOTHERAPY  47 

Experience  With  Epilepsy.  The  problem  of  the  endocrine 
aspects  of  epilepsy,  which  is  treated  much  more  fully  else- 
where, is  mentioned  by  way  of  lending  further  emphasis  to 
the  matter  under  discussion.  We  do  not  know  in  advance 
that  a  given  case  has  a  definite  endocrine  disturbance  of 
sufficient  severity  to  be  responsible  for  the  difficulties  which 
bring  the  patient  to  our  notice.  Yet,  on  the  other  hand, 
since  the  problem  is  so  inherently  difficult,  and  ordinarily  is 
treated  in  a  very  unsatisfactory  manner  by  the  administra- 
tion of  sedatives  of  various  kinds  and  the  attempt  to  modify 
presumed  underlying  conditions  such  as  toxemia,  dietetic 
errors,  etc.,  why  is  it  not  perfectly  good  practice  to  treat  a 
case  of  epilepsy  with  an  organotherapy  which  has  been  help- 
ful in  some  other  case,  in  the  hope  that  the  response  to  such 
organotherapy  not  merely  may  modify  or  cure  the  epilepsy 
but  at  the  same  time  establish  more  firmly  in  our  minds,  or 
disprove,  as  the  case  may  be,  its  presumed  underlying  en- 
docrine aspects. 

My  personal  experience  has  assured  me  in  many  cases  that 
the  response  of  the  individual  to  an  organotherapy  often 
gives  us  diagnostic  information  of  very  considerable  value, 
and  with  this  in  mind  I  cannot  but  feel  even  more  justified 
in  recommending  a  presumably  indicated  pluriglandular 
therapy,  in  a  given  case  or  class  of  cases,  merely  because, 
in  the  event  that  the  results  do  not  materialize  within  a 
reasonably  long  period  of  time,  we  can  console  ourselves  that 
this  aspect  of  the  case  is  of  minor  importance  and  that 
we  must  look  elsewhere  to  accomplish  something  for  the 
patient. 

Unfounded  Criticism.  I  realize,  of  course,  that  this  atti- 
tude of  mine  has  been  the  cause  of  a  good  share  of  the 
criticisms  advanced  by  those  who  feel  that  they  must  be 
thorough  and  accurate  and  sure  of  all  the  features  of  a  con- 
dition before  they  treat  the  patient.  But  I  have  yet  to  find 
an  ordinary  physician  or  an  endocrinologist  who  has  made  a 
special  study  of  the  subject,  who  can  in  advance  determine 
an  accurate  endocrine  diagnosis  and  apply  thereto  an  ac- 
curate endocrine  therapy.  It  happens  that  many  of  these 
scientists,  who  are  ready  to  condemn  me,  admit,  when 
pinned  down,  that  they  are  almost  as  ignorant  as  the  rest 
of  us!  And,  in  this  connection,  I  cannot  help  adding  that 
most  of  these  critics  pass  their  judgment  and  make  their 
statements  with  little  or  no  personal  clinical  experience  from 
which  to  draw,  a  tendency  by  the  way,  which  is  customarily 
manifested  towards  "new  ideas." 


48 


The  peculiar  phenomenon  known  as  anaphylaxis,  or  pro- 
tein sensitization,  becomes  quite  interesting  to  those 
physicians  who  make  a  persistent  study  of  the  internal 
secretions  and  organotherapy.  Undoubtedly  this  reaction 
of  the  organism  may  have  a  much  more  intimate  relation- 
ship to  the  ductless  glands  and  their  hormones  than  has 
been  appreciated  heretofore,  and  some  personal  observa- 
tions may  be  related  here  to  further  an  interest  in  the  study 
and  appreciation  of  the  importance  of  this  matter. 

Protein  poisoning,  like  any  other  toxemia,  necessarily 
must  invariably  involve  the  detoxicating  mechanism,  and 
since  this  undoubtedly  is  presided  over  by  the  thyroid  and 
allied  endocrine  glands,  whenever  we  run  across  an  indi- 
vidual who  is  sensitive  to  certain  proteids,  naturally  we 
become  interested  in  the  functional  capacity  of  these  regu- 
lators of  metabolism.  For  example,  some  physicians  now 
believe  that  certain  forms  of  high  blood-pressure  are  ex- 
amples of  the  anaphylaxis-like  reaction  of  the  body  to  cer- 
tain protein  toxins,  and,  if  this  is  the  case,  the  study  and 
treatment  of  hypertension  should  involve  the  search  for 
these  poisons  and  their  removal  as  far  as  possible,  as  well 
as  the  encouragement  of  the  overburdened  endocrine  organs, 
or,  on  the  other  hand  the  encouragement  of  the  opposing 
organs  which  maintain  the  so-called  "hormone  balance". 

As  we  are  confronted  with  individuals  with  peculiar  sen- 
sitization to  various  foods,  it  is  surprising  how  many  of 
them  also  have  some  endocrine  disturbance.  The  reverse 
is  equally  true.  Asthma,  which,  to  my  way  of  thinking, 
many  times  is  largely  a  matter  of  anaphylaxis,  is  very 
commonly  associated  with  dyscrinism  involving  sometimes 
the  thymus,  sometimes  the  pituitary,  and  at  other  times 
the  adrenals. 

Anaphylaxis  and  Hypoadrenia.  The  influences  that  pro- 
tein poisoning  has  upon  the  endocrine  glands  is  of  great 
importance.  When  an  individual  has  an  anaphylactic  reac- 
tion he  is  virtually  suffering  from  an  acute  protein  poison- 
ing, and,  as  in  other  poisonings  with  varied  origins,  one 
expects  the  natural  defense  of  the  body  to  poisons  to  be 
involved.  Consequently  there  is  a  very  large  adrenal  side 


ANAPHYLAXIS  AND  THE  ENDOCRINES  49 

to  conditions  of  this  kind.  We  find  that  not  infrequently 
hypoadrenia  accompanies  or  follows  anaphylaxis;  and  the 
regulation  of  this  adrenal  insufficiency  often  helps  the  "let 
down"  resulting  from  the  anaphylaxis.  We  also  find  occa- 
sional hints  in  therapeutic  literature  indicating  that  adrenal 
therapy,  or,  more  correctly,  adrenalin  therapy,  is  used  to 
modify  or  prevent  the  nitroid  crises  which  accompany  sal- 
varsan  injections  (personally,  I  believe  that  the  trouble  is 
not  entirely  arsenical  but  rather  the  result  of  protein 
products  broken  up  and  released  into  the  organism  by  the 
severe  arsenic  toxemia  and  a  consequent  protein  poisoning 
plus  arsenic  poisoning).  Again,  adrenalin  has  been  used 
with  good  success  in  urticaria  which,  as  we  know,  is  one  of 
the  manifestations  of  serum  sickness,  anaphylaxis,  and 
other  evidences  of  protein  poisoning. 

The  condition  known  as  status  lymphaticus  and  its  un- 
fortunate outcome — thymus  death — always  has  seemed  to 
me  akin  to  anaphylaxis,  and  if  so,  dyscrinism  is  once  more 
related  to  this  phenomenon  for  the  thymus  is  believed  to  be 
an  endocrine  organ.  The  so-called  "serum  sickness"  and 
the  occasional  deaths  of  children  following  serum  treat- 
ment, seem  to  be  in  the  same  category  and  we  know,  at 
least,  that  some  cases  dying  under  these  circumstances 
are  found  at  autopsy  to  have  had  thymus  enlargement, 
status  lymphaticus  and  the  disorganization  resulting  there- 
from. 

For  some  years  I  have  been  studying  epilepsy  from  the 
standpoint  of  the  ductless  glands.  Quite  a  good  many  hints 
in  our  experience  indicate  that  there  may  be  some  anaphy- 
lactic  aspect  to  the  epileptic  manifestations.  For  example: 
I  recall  a  case  where  there  was  a  bad  post-abortion  infec- 
tion. The  endocrine  balance  was  very  sadly  deranged,  and 
this  individual  from  that  time  began  to  have  increasingly 
severe  epileptic  seizures.  It  was  believed  that  this  par- 
ticular epilepsy  was  a  toxemia  (and  the  consensus  of  opin- 
ion emphasizes  the  fact  that  if  it  is  not  exactly  a  condition 
of  poisoning,  it  is  very  seriously  aggravated  by  all  forms  of 
toxemia)  either  brought  about  by  or  aggravated  by  the 
dysovarism.  Regulation  of  this  condition  not  merely 
changed  the  obvious  menstrual  irregularities,  but  disposed 
of  the  associated  epilepsy;  in  other  words,  there  was  re- 
established a  more  nearly  normal  hormone  balance  favor- 
ing the  disposal  of  the  underlying  condition  of  toxemia 
which  is  believed  to  be  a  factor  in  bringing  about  the 
epilepsy. 


50  PRACTICAL   ORGANOTHERAPY 

Hyperemesis  Gravidarum  an  Anaphylaxis.  Again:  the 
matter  of  the  nausea  and  vomiting  of  pregnancy  may  be 
considered  from  the  standpoint  of  anaphylaxis.  It  is  well 
known  that  the  discomforts  of  the  earlier  months  of  preg- 
nancy are  due  to  a  toxemia,  and  the  attitude  of  those  who 
believe  that  this  toxemia  is  connected  with  the  production 
by  the  placenta  of  certain  protein  substances  to  which  the 
body  reacts  unfavorably,  seems  to  have  been  substantiated 
by  a  good  deal  of  clinical  experience.  But  the  interesting 
point  is  that  when  an  individual  who  is  presumed  to  be  sen- 
sitive to  these  placental  proteins  is  fed  placenta  substance, 
and  an  attempt  is  made  to  increase  the  immunity  of  the  body 
to  them,  there  shortly  ensues  in  a  generous  percentage  of 
cases  a  tolerance  to  the  toxemia  which  puts  an  end  to  the 
vomiting  no  matter  how  serious  it  might  have  been.  (It  is 
interesting  to  note  how  frequently  persons  with  an  aggra- 
vated tendency  to  the  toxemia  of  pregnancy  will  tell  of  dif- 
ficulties that  they  have  in  connection  with  eating  strawber- 
ries, or  shell  fish,  or  eggs,  i.  e.,  certain  foods  to  which  a 
very  small  minority  is  sensitive.  The  same  is  true  in  certain 
cases  of  asthma.) 

Organotherapeutic  Sensitiveness.  In  my  experience  with 
endocrine  therapy  I  occasionally  run  across  individuals 
whose  clinical  findings  indicate  the  necessity  for  certain 
glandular  remedies,  and  who,  after  such  therapy  has  been 
inaugurated,  react  unfavorably  to  the  extracts,  and,  de- 
spite every  effort  to  cover  up  the  product,  find  that  they 
cannot  take  them  at  all.  They  are  nauseated;  they  break 
out  into  a  rash;  they  suffer  from  sympatheticotonus,  i.  e., 
their  sympathetic  system  seems  to  be  considerably  more  on 
edge  than  usual,  and  in  many  ways  they  discover  that  they 
react  unfavorably  to  the  remedy.  Fortunately  such  indi- 
viduals are  few  and  far  between.  I  have  tried  to  get  some 
figures,  and  imagine  that  perhaps  1:3000  is  not  far  from 
correct.  In  other  words,  these  individuals  are  like  those 
unfortunates  who  cannot  eat  strawberries  or  in  whom  there 
is  an  unpleasant  reaction  to  other  special  foods  already 
mentioned,  and,  interestingly  enough,  often  these  persons 
with  idiosyncrasies  to  glandular  extracts,  already  have  dis- 
covered a  similar  intolerance  to  other  foods.  I  have  re- 
peatedly attempted  to  get  around  this  difficulty,  and  while 
in  some  cases  I  have  succeeded  in  increasing  the  tolerance, 
in  others  I  have  failed  absolutely,  merely  because  no  matter 
how  small  the  dose,  or  how  apparently  effectually  it  was 
hidden,  the  patients  would  immediately  assure  me  that  they 


ANAPHYLAXIS  AND  THE  ENDOCRINES  51 

were  having  the  same  series  of  troubles  which  initiated  the 
investigation  along  these  lines. 

A  fertile  field  of  study  in  protein  sensitization  and  organ- 
otherapy is  the  development  of  a  means  whereby  we  can 
control  those  reactions  of  the  body  of  an  anaphylactic  char- 
acter which  either  are  causing  disease,  as  asthma,  urticaria, 
nausea  and  vomiting,  etc.,  or  are  interfering  with  our  well- 
meant  attempts  to  modify  various  dyscrinisms  by  means  of 
the  administration  of  organotherapeutic  proteins. 

Conclusions — The  subject  is  still  in  a  formative  stage,  but 
some  suggestive  conclusions  may  be  made  tentatively  with 
advantage : 

1.  Protein  metabolism  is  related  to  the  internal  secre- 
tions; hence  disturbances  in  the  routine  of  protein 
metabolism  may  be  connected  with  a  disturbed  endo- 
crine function; 

2.  Anaphylaxis,  or  protein  sensitization,  may  involve  the 
endocrine  glands,  and  a  part  of  the  reaction  connected 
with  these  idiosyncrasies  may  involve  the  ductless 
glands,  especially  the  adrenals,  thyroid,  and  in  cer- 
tain rarer  instances,  the  thymus; 

3.  Hypoadrenia    of    anaphylactic    origin    needs    to    be 
treated  like  adrenal  insufficiency  of  any  other  toxic 
origin;  in  other  words,  adrenal  support  is  a  reason- 
able measure  in  the  case  of  anaphylaxis ; 

4.  Occasionally,  protein  sensitization  may  be  overcome 
by  the  establishment  of  an  immunity,  as  is  routinely 
done  in  the  treatment  of  hydrophobia  or  the  admin- 
istration of  bacterial  vaccines.    In  vomiting  of  preg- 
nancy, placenta  substance  administered  over  a  period 
seems  to  favor  an  immunity  to  the  placental  proteins 
and  a  consequent  control  of  the  toxic  irritability ; 

5.  Occasionally  organotherapeutic  measures  bring  about 
an  anaphylactic  reaction,  and  this  is  particularly  true 
in  individuals  already  sensitive  to  other  food  pro- 
teins ; 

6.  Whenever  a  clinical  hint  attracts  attention  to  protein 
sensitization,  the  endocrines  should  be  studied  and 
brought  into  the  matter  both  from  the  standpoint 
of  diagnosis  as  well  as  treatment. 


SECTION    III. 

PLURIGLANDULAR  FORMULAS 


A  number  of  fundamental  forms  of  pluriglandular 
therapy  are  represented  by  a  series  of  formulas  made  in  my 
laboratory  of  applied  endocrinology.  These  formulas  con- 
stitute a  well-considered  effort  to  apply  the  essential  prin- 
ciples of  organotherapy  to  several  fairly  large  groups  of 
cases.  Each  of  these  pluriglandular  prescriptions  has  been 
used  repeatedly,  and  it  is  with  a  confidence  born  of  results — 
sometimes  unexpected  results — that  they  are  recommended 
here. 

The  following  statements  embody  the  essential  informa- 
tion regarding  these  stock  formulas.  In  Section  V,  "Every- 
day Organotherapy,"  further  consideration  is  given  to 
various  phases  of  the  subject.  Additional  explanatory  lit- 
erature regarding  several  of  these  preparations  is  available 
on  request,  and  the  writer  has  accumulated  a  quantity  of 
enthusiastic  complimentary  statements  which  are  published 
from  time  to  time,  copies  of  which  also  will  be  sent  to  inter- 
ested physicians. 

The  prescriber  is  advised  to  call  for  a  full  box  of  100 
doses  since  organotherapy  is  an  attempt  to  reestablish  some 
function,  and  a  feiv  doses  accomplish  virtually  nothing.  It 
is  desirable  to  specify  "Harrower,"  at  least  until  the  phar- 
macist is  acquainted  with  the  products  of  this  laboratory. 

Attention  is  again  called  to  the  fact  that  no  trade  names 
are  used,  the  formulas  are  neither  secret  nor  ambiguousf 
and  the  labels  contain  no  indications  nor  the  boxes  anyf 
explanatory  circulars.  In  other  words,  every  effort  has 
been  made  to  be  as  ethical  and  professional  as  possible. 

NO.  1.    ADRENO-SPERMIN  CO. 

ASTHENIA;    Hypotension;    Neurasthenia;    Hypoadrenia; 

Run-down  Conditions. 

Formula:  Each  five  grains  represents  the  following  com- 
bination: Adrenal  substance  (total)  gr.  !/i»  Thyroid  gland 
(U.  S.  P.  IX)  gr.  1/12,  Spermin  extract  (from  gonads)  gr. 
2  with  Calcium  Glycero-phosphate  q.  s. 

53 


54  PRACTICAL  ORGANOTHERAPY 

Prescribe  Thus:  1>  Adreno-Spermin  Co.  (Harroiver)  No. 
C.  Sig.  One,  q.  i.  d.  just  before  meals  and  at  bedtime.  (In 
acute  cases  and  under  special  circumstances,  one  every  three 
hours.) 

Physiological  Effects :  A  support  to  depleted  adrenal  func- 
tion, hence  a  means  of  reducing  neuro-muscular  asthenia  due 
to  hypoadrenia.  Favors  sympathetic  tone,  stimulates  oxi- 
dation, encourages  cardiac  activity,  opposes  circulatory 
stasis  and  increases  "dynamos."  An  organotherapeutic 
tonic  and  reconstructant. 

Indications:  Chronic  asthenic  conditions  with  deficient 
oxidation  (low  urinary  elimination)  such  as  accompany 
chronic  toxemia  and  follow  acute  infectious  diseases,  es- 
pecially influenza,  pneumonia,  etc.  The  "fatigue  syndrome" 
and  run-down  states  with  low  blood  pressure,  cardio- 
circulatory  insufficiency  (cold  extremities)  and  subnormal 
temperature.  Many  functional  neuroses  including  neuras- 
thenia, psychasthenia,  melancholia,  etc. 

Remarks:  Should  be  given  early  in  acute  conditions  as  a 
prophylactic  against  the  expected  "let-down,"  which  is 
almost  invariably  an  adrenal  syndrome.  Continue  for  3  or  4 
weeks,  beginning  with  1  every  3  hours,  ending  with  1,  t.  i.  d. 
In  chronic  asthenias  the  blood  pressure  is  an  excellent  guide 
both  as  to  dosage  and  length  of  administration.  A  B.  P. 
(systolic)  of  110  mm.  calls  for  1,  t.i.d.,  of  100  mm.  1,  q.i.d. 
and  90  mm.  or  less  1,  5  or  even  6  times  a  day.  The  longer 
the  symptoms  have  persisted  the  larger  the  initial  dose  and 
the  longer  the  treatment — up  to  3  or  more  months. 

Reference:  Sec.  IV,  Ch.  5;  Sec.  V,  Ch.  1,  2,  4,  17,  18; 
Sec.  VI,  Ch.  1,  2,  6,  9,  13,  16,  20,  24,  26. 

NO.  2.    ANTERO-PITUITARY  CO. 

DEFECTIVE  CHILDREN;  Maldevelopment;  Infantilism; 
Cretinism;  Epilepsy. 

Formula:  Each  five  grains  represents  the  following  com- 
bination: Pituitary  gland  (anterior  lobe)  gr.  2;  Thymus 
gland,  gr.  1;  Thyroid  gland  (U.  S.  P.  IX)  gr.  1/12  with 
Calcium  Phosphorus  Co.  (see  No.  11)  q.  s. 

Prescribe  Thus:  ^  Antero-Pituitary  Co.  (Harrower) 
No.  C.  Sig.  In  children  under  five  years  one  twice  a  day  at 
meals,  for  4  out  of  every  5  weeks.  Continue  for  several 
months.  (In  larger  children,  and  later  in  the  treatment,  an 
additional  dose  is  advisable.) 

Physiological  Effects:  A  growth  stimulant  (morphogenic) 


PLURIGLANDULAR  THERAPY  55 

and  endocrine  regulator  in  defective  development — hypo- 
plasia — in  children  and  youth.  Found  to  have  a  favorable 
influence  on  petit  mat  and  epilepsy  for  reasons  not  well  de- 
fined, presumably  due  to  a  hypopituitaric  factor  in  the 
etiology  of  these  conditions. 

Indications:  Children  with  obvious  endocrine  deficiencies 
— thyroid,  pituitary,  etc.  Retarded  mentality  (so-called 
"backward  children"  with  or  without  decided  stigmata), 
deficient  growth,  mongolism,  dwarfism,  etc.  Epilepsy,  petit 
mal,  chorea  and  indefinite  disorders  which  may  be  asso- 
ciated with  or  due  to  dyscrinism.  As  a  means  of  broadening 
the  use  of  thyroid  in  cretinism. 

Remarks:  Results  have  been  both  remarkable  and  unex- 
pected, while,  on  the  other  hand,  this  formula  has  been  often 
used  in  organic  cases  with  definite  cerebral  defects  with  no 
benefit  whatever.  This  cannot  be  determined  in  advance,  so 
this  treatment  is  often  a  "last  straw"  which  is  well  worth 
trying.  Must  be  given  with  the  understanding  that  results 
are  possible  but  not  necessarily  probable,  and  also  that  it  is 
useless  to  give  it  for  less  than  4  to  6  months.  Small  doses — 
2  or  3  a  day — for  long  periods  are  better  than  larger  doses 
for  a  shorter  time. 

Reference:  Sec.  IV,  Ch.  5,  7,  11,  12;  Sec.  VI,  Ch.  4,  18, 
21,  25. 

NO.  3.   PLACENTO-MAMMARY  CO. 

GALACTAGOGUE ;  Post-partum  stimulant;  Uterine  invo- 
lutant. 

Formula:  Each  five  grains  represents  the  following  com- 
bination: Desiccated  placenta  gr.  2,  Mammary  substance 
gr.  li/9.  Pituitary  body  (total)  gr.  1/3  with  Calcium  Phos- 
phorus Co.  (Harrower)  q.  s. 

Prescribe  Thus:  J£  Placento-Mammary  Co.  (Harrower) 
No.  C.  Sig.  Two  at  meals  t.  i.  d.  for  first  10  days,  thereafter 
one,  t.  i.  d. 

Physiological  Effects:  Mammary  stimulant,  galactagogue ; 
post-partum  regulator  by  favoring  uterine  involution.  Bene- 
ficial influence  upon  infant's  weight  and  nutrition. 

Indications:  Deficient  or  poor  milk  secretion,  agalactia, 
hypogalactia.  Infantile  malnutrition.  Preferably  as  a 
prophylactic  especially  in  mothers  whose  previous  nursing 
experiences  were  not  good. 

Remarks:  Push  the  dosage  for  the  first  period,  then 
reduce  the  dose  until  at  three  weeks  or  a  month  it  may  be 


56  PRACTICAL  ORGANOTHERAPY 

omitted.  In  some  cases  it  has  been  given  throughout  the 
whole  nursing  period,  since  its  omission  caused  a  return  of 
the  hypogalactia  within  a  few  days.  It  has  been  noted  that 
the  use  of  this  formula  seems  to  inhibit  menstruation  dur- 
ing the  nursing  months,  a  distinct  advantage  both  to  mother 
and  child. 
Reference:  Sec.  IV,  Ch.4;  Sec.  V,  Ch.  8;  Sec.  VI,  Ch.  31. 

NO.  4.    THYRO-OVARIAN  CO. 

DYSOVARISM;  Amenorrhea ;  Dysmenorrhea;  Neurasthe- 
nia; Menopause. 

Formula :  Each  five  grains  represents  the  following  com- 
bination: Ovarian  substance  (total)  with  Corpus  luteum 
gr.  2i/2;  Thyroid  gland  (U.  S.  P.  IX)  gr.  1/12;  Pituitary 
body  (total)  gr.  y$  with  Calcium  Phosphortis  Co.  (Har- 
rower)  q.  s. 

Prescribe  Thus:  1$  Thyro-Ovarian  Co.  (Harrower)  No. 
C.  Sig.  One,  t.  i.  d.,  a.  c.  for  10  days,  double  dose  for  7  to 
10  days  before  menses,  omit  at  onset  of  menses  for  10  days. 
Repeat.  (In  total  amenorrhea:  1,  t.  i.  d.  for  10  days,  2, 
t.  i.  d.  for  2  weeks ;  omit  a  week ;  repeat.) 

Physiological  Effects:  Ovaro-uterine  regulator  through 
the  endocrine  function  of  the  ovaries  and  also  the  associated 
synergistic  ductless  glands. 

Indications:  Amenorrhea  (delayed,  scanty,  absent  or  dif- 
ficult menses) ;  dysmenorrhea ;  sterility ;  sexual  apathy ; 
numerous  neuroses  and  psychoses  connected  with  the  men- 
strual function.  Epilepsy  of  the  ovarian  type  (onset  related 
to  ovarian  function  or  character  aggravated  in  relation  to 
periods).  Climacteric  disorders  and  circulatory  imbalance 
of  ovarian  endocrine  origin. 

Remarks:  This  is  one  of  the  most  efficient  endocrine 
remedies.  The  fact  that  the  associated  endocrine  glands  are 
taken  into  consideration  (for  it  may  well  be  that  the  whole 
trouble  is  not  so  much  ovarian  as  thyroid  or  pituitary,  as 
both  physiology  and  clinical  experience  have  repeatedly 
shown)  has  made  the  use  of  this  formula  helpful  when 
corpus  luteum  or  ovarian  substance  alone  had  been  tried 
previously  for  long  periods  without  results.  The  cyclic 
method  of  administering  suggested  above  is  much  more  sat- 
isfactory than  the  usual  signature,  "one,  three  times  a 
day." 

Reference:  Sec.  IV,  Ch.  8;  Sec.  V,  Ch.  5,  6,  7;  Sec.  VI, 
Ch.  3,  12,  17. 


PLURIGLANDULAR  THERAPY  57 

NO.  5.   HEPATO-SPLENIC  CO. 

INTESTINAL  STASIS;  Hepato-biliary  Insufficiency;  Ali- 
mentary Toxemia;  Malnutrition. 

Formula:  Each  five  and  a  half  grains  represents  the  fol- 
lowing combination:  Hepatic  parenchyma  and  desiccated 
spleen  substance  aa  gr.  2,  Spermin  Extract  gr.  1,  Adrenal 
substance  gr.  14  and  Thyroid  (U.  S.  P.)  gr.  1/20. 

Prescribe  Thus:  I>  Hepato-Splenic  Co.  (Harrower)  No. 
3.  Sig.  One  after  each  meal  and  at  bed  time.  (In  certain 
instances  the  dose  may  be  doubled  and  in  any  event  dosage 
should  be  continued  for  weeks.) 

Physiological  Effects:  Alimentary  stimulant  and  regula- 
tor through  the  liver  and  spleen  mechanism,  as  well  as 
through  the  general  endocrine  system.  A  means  of  en- 
couraging the  secretory  and  detoxicative  powers  of  the 
liver.  Favors  nutritive  exchanges  and  has  been  known  to 
stimulate  large  increases  in  weight. 

Indications:  Malnutrition  of  long-standing,  toxic  origin, 
especially  in  cachexia,  tuberculosis,  malaria,  etc.  Hepato- 
biliary  insufficiency  and  sluggishness,  resulting  in  intestinal 
stasis  and  toxemia. 

Remarks:  It  seems  that  this  organotherapeutic  formula 
goes  deeper  than  one  expects  of  an  ordinary  hepatic  stimu- 
lant. There  is  a  support,  a  sort  of  physiological  encourage- 
ment, which  is  more  satisfactory  than  the  usual  "liver  medi- 
cines." It  should  be  remembered  that  this  preparation  ex- 
erts an  educative  influence  and  should  be  continued  for  some 
time,  especially  in  the  chronic  cases  of  alimentary  laziness. 

Reference:    Sec.  V,  Ch.  2,  22,  23. 

NO.  6.    PANCREAS  CO. 

SYMPATHETIC  IRRITABILITY;  Hyperthyroidism;  Heart 
Hurry  and  Cardiac  Weakness. 

Formula:  Each  five  grains  represents  the  following  com- 
bination: Adrenal  and  Pituitary  glands  (total)  aa  gr.  V&» 
Ovarian  substance  gr.  1  and  Pancreas  gland  (total)  gr.  3. 

Prescribe  Thus:  I£  Pancreas fo.  (Harrower)  No.  C.  Sig. 
One,  q.  i.  d.,  between  meals.  v^n  acute  cases,  especially  in 
severe  hyperthyroidism,  the  amount  may  be  increased  to 
6  or  8  a  day  for  a  time.) 

Physiological  Effects:  A  cardiac  muscular  support  and 
sedative.  Functional  antagonist  to  sympathetic  irritability, 
especially  that  due  to  excessive  thyroid  secretion.  Ovarian 


58  PRACTICAL  ORGANOTHERAPY 

content  suggested  by  Crotti,  since  dysovarism  is  so  common 
in  such  cases.  (No  objection  to  using  same  formula  in 
men,  however.) 

Indications:  Irritable,  irregular,  rapid  and  weak  pulse, 
especially  of  endocrine  origin.  Nervousness  and  irritability 
resulting  from  hyperthyroidism.  Post-influenzal  and  other 
toxic  asthenias  with  a  susceptible  thyroid. 

Remarks:  A  sympathetic  sedative  and  useful  remedy  in 
hyperthyroidism,  but  with  practically  no  direct  influence 
upon  the  causative  factors  in  this  disease.  Must  be  used 
with  other  measures,  especially  those  calculated  to  antag- 
onize or  remove  (1)  sources  of  toxemia — teeth,  tonsils, 
sinuses,  colon,  gall  bladder,  pelvis  or  elsewhere,  (2)  dyscrin- 
ism,  especially  disturbed  functions  of  the  ovaries  or  a  per- 
sistent thymus  or  (3)  emotional  and  psychic  conditions 
which  may  and  do  unduly  stimulate  the  thyroid  and  adrenal 
glands.  An  excellent  means  of  preparing  a  case  of  toxic 
goitre  for  indicated  surgery,  and  a  worth-while  remedy  in 
severe  toxemias  where  more  radical  measures  are  contra- 
indicated. 

Reference:     Sec.  V,  Ch.  10 ;  Sec.  VI,  Ch.  5,  22,  23. 

NOS.  7,  8,  9.     THYROID  CO.  GR.  »/8,  '/4,  '/2 

HYPOTHYROIDISM;  Myxedema;  Cretinism;  Minor  Thy- 
roid Insufficiencies. 

Formula:  Each  five  grains  represents  one  eighth,  one 
quarter  or  one  half  a  grain  of  U.  S.  P.  (IXth  edition)  Thy- 
roid gland,  respectively,  with  Calcium  Phosphorus  Co.  q.  s. 

Prescribe  Thus:  ^  Thyroid  Co.  (Harrower)  gr.  i/8  (or 
14  or  i/£,  as  desired)  No.  C.  Sig.  One  t.  i.  d.  before 
meals. 

(Note:  In  many  instances  a  routine  "step  ladder  dosage" 
is  available,  thus :  For  a  week  give  one  daily  dose  of  No.  9, 
during  the  second  week  give  2  doses  a  day,  during  the  third 
week  3  doses  a  day  and  during  the  fourth  week  4  doses  a 
day.  Omit  entirely  during  the  fifth  week ;  and,  if  necessary, 
repeat.  This  allows  of  the  determination  of  the  optimal 
dosage  or  tolerance  by  noting  the  response  of  the  patient 
and  with  no  harm  whatever.) 

Physiological  Effects:  Supplementary  organotherapy  in 
functional  or  organic  thyroid  secretory  insufficiency.  Re- 
mineralization.  (See  No.  11.) 

Indications:  Hypothyroidism — myxedema,  with  lesser 
forms  of  thyroid  insufficiency,  manifesting  various  degrees 


PLURIGLANDULAR  THERAPY  59 

of  infiltration  (of  skin,  mucous  membrane  and  tissues  gener- 
ally), suboxidation,  obesity,  dermatoses  or  ovarian  dystro- 
phies. Cretinism,  with  maldevelopment,  mental  backward- 
ness, mongolism,  etc.  In  many  nutritional  disorders  with 
metabolic  insufficiency  and  defective  elimination. 

Remarks:  The  addition  of  the  mineral  salts  to  thyroid 
extract  is  based  on  sound  reasoning,  and  clinical  experience 
emphasizes  its  value.  Thyroid  extract  is  practically  always 
given  in  the  hope  of  increasing  cell  chemistry,  for  any  de- 
gree of  hypothyroidism,  from  the  least  to  the  most  serious, 
always  entails  reduced  metabolism  and  a  consequent  exces- 
sive production  of  acid  wastes  which  automatically  rob  the 
organism  of  its  alkaline  reserve.  This  explains  the  acidosis 
and  cellular  poisoning  which  is  the  rule  in  thyroid  insuf- 
ficiencies, and  at  the  same  time  supplements  the  thyroid 
gland  stimulation  by  means  of  remineralization  or  restoring 
the  alkaline  mineral  salts  that  have  been  depleted.  Hence 
the  excipient,  used  instead  of  milk  sugar  or  starch,  may 
be  as  therapeutically  useful  as  the  thyroid  itself. 

Reference:    Sec.  IV,  Ch.  2,  3 ;  Sec.  V,  Ch.  3,  13. 

NO.  10.    THYROID  TESTING  CAPSULES 

THYROID  TEST;  Differential  Diagnosis  of  Goitre;  Estima- 
tion of  Thyroid  Secretion. 

Formula:  Each  small  box  (of  which  there  are  three  in 
each  package)  contains  twelve  graduated  capsules  of  thyroid 
extract — four  small,  four  medium  and  four  large — repre- 
senting one  half,  one  and  two  grains  of  U.  S.  P.  Thyroid, 
respectively. 

Prescribe  Thus:  I?  One  Thyroid  Test  (Harrower),  with 
chart.  Sig.  Follow  printed  instructions  carefully. 

Physiological  Effects:  A  routine,  graduated  thyroid  func- 
tion stimulant,  bringing  about  a  reaction  which  varies  in 
different  individuals  in  proportion  to  the  thyroid  sensitive- 
ness or  apathy  that  is  present,  which  may  be  recorded  upon 
a  simple,  specially  arranged  pulse  chart  which  serves  for 
comparison  between  different  cases,  or  the  same  case  under 
different  circumstances.  A  means  of  measuring  thyroid 
functional  activity. 

Indications :  In  all  forms  of  simple  goitre  and  where  thy- 
roid enlargement  is  not  obviously  due  to  a  well-established 
hyperthyroidism.  As  a  differential  diagnostic  measure  be- 
tween goitre  due  to  thyroid  secretory  incapacity  or  over- 
stimulation.  As  a  means  of  discovering  a  latent  thyroid 


60  PRACTICAL  ORGANOTHERAPY 

sensitiveness  without  goitre.  Also  valuable  in  the  study 
of  metabolic  dyscrasias,  as  obesity,  rheumatism,  etc.— 
where  it  is  presumed  that  a  thyroid  element  may  be  pres- 
ent, and  where  thyroid  stimulation  properly  may  be  added 
to  the  treatment  if  the  test  shows  the  need  for  such  treat- 
ment. 

Remarks:  A  simple  and  extremely  convenient  measure — 
the  physician  has  only  to  hand  the  package  to  the  patient  or 
prescribe  it,  as  the  instructions  are  minutely  outlined  with 
the  chart  which  accompanies  the  test — which  places  thyroid 
medication  upon  a  rational  basis,  instead  of  the  administra- 
tion of  this  remedy  haphazard  and  until  the  patient  com- 
plains of  the  untoward  reaction  due  to  overstimulation  of 
the  gland.  Not  alone  useful  in  goitre  and  presumed  thyroid 
troubles,  but  especially  worth  while  in  the  study  of  dis- 
turbed cell  chemistry,  in  ovarian  disorders,  in  nutritional 
disturbances  and  in  many  cases  where  the  discovery  of  thy- 
roid irritability  or  apathy,  as  the  case  may  be,  would  offer  a 
new  angle  from  which  to  consider  and  treat  the  case. 

Reference:  Sec.  IV,  Ch.  4,  12;  Sec.  V,  Ch.  3,  18;  Sec.  VI, 
Ch.  3,  12  . 

NO.  11.    CALCIUM  PHOSPHORUS  CO. 

DEMINERALIZATION;  Hyperacidity  (Acidosis  or  Ad- 
denda); Toxemias. 

Formula:  Each  tablet  contains  IS1/^  grains  (one  gram)  of 
the  following  combination:  One  hundred  parts  represents 
Magnesium  Phosphate  2,  Calcium  Phosphate  (dibasic)  and 
Calcium  Glycerophosphate  aa  8,  Potassium  Bicarbonate  32 
and  Sodium  Bicarbonate  q.  s. 

Prescribe  Thus:  _.!£  Calc.  Phosphorus  Co.  (Harroiver) 
No.  C.  Sig.  3  tablets,  crushed,  with  much  water,  twice  a  day, 
one  hour  before  food. 

Physiological  Effects:  Neutralizes  systemic  acid  wastes. 
Replaces  the  alkaline  mineral  reserve,  depleted  by  poor  oxi- 
dation and  abnormal  production  of  acid  or,  at  least,  "alka- 
line robbing"  products.  This  condition  of  mineral  depletion 
is  known  in  France  as  "demineralization"  and  the  therapy 
as  "remineralization." 

Indications:  Particularly  useful  in  the  adjunct  treatment 
of  chronic  toxemic  conditions,  especially  those  so  commonly 
associated  with  endocrine  insufficiencies  (notably  of  the 
thyroid  gland).  Indicated  in  a  large  list  of  chronic  disor- 
ders in  conjunction  with  gland  feeding  and  other  measures. 


PLURIGLANDULAR  THERAPY  61 

Remarks:  The  above  formula  (with  the  addition  of  so- 
dium chloride)  contains  the  mineral  salts  in  the  approxi- 
mate proportions  present  in  the  blood,  and  is  the  standard 
excipient  in  The  Harrower  Laboratory.  In  many  cases  it 
is  advisable  to  push  the  dosage  for  the  first  few  weeks  of  the 
treatment  with  pluriglandular  therapy  and  this  non-glandu- 
lar "mineral  food"  was  added  to  the  list  since  it  is  so  com- 
monly and  definitely  useful  in  these  conditions.  At  least 
six  grams  a  day  should  be  given  to  an  adult  during  the  first 
two  or  three  weeks  of  treatment,  the  dose  then  being 
reduced  to,  say,  four  grams  every  other  day,  or  less  often, 
depending  upon  the  development  of  the  conditions  which 
may  be  present. 

Reference:    Sec.  V,  Ch.  2, 10, 18,  25 ;  Sec.  VI,  Ch.  15. 

NO.  12.    AMYLO-TRYPSIN  CO. 

INDIGESTION;  Flatulence;  Gastric  Dilatation,  etc. 

Formula :  Each  five  grains  represents  the  following  com- 
bination: Amylopsin  (pancreatic  diastase)  gr.  l/z,  Pan- 
creatin  (U.  S.  P.  IX)  gr.  2Vfcf  Papain  gr.  1/2 »  Berberine  sul- 
phate gr.  1/12  and  a  mixture  of  Cinnamon,  Nutmeg  and 
Jamaica  Ginger,  q.  s. 

Prescribe  Thus:  ^  Amylo-Trypsin  Co.  (Harrower)  No. 
C.  Sig.  Two,  two  hours  after  eating. 

Physiological  Effects:  The  first  three  ingredients  further 
the  digestion  of  proteid  and  starch,  according  to  principles 
well  established  in  physiological  chemistry.  Berberine  is 
the  yellow  alkaloid  of  golden  seal  (and  also  the  barberry) 
and  is  an  efficient  mucosal  tonic;  while  the  excipient  con- 
sists of  the  well-known  plant  carminatives.  A  polyenzyme, 
tonic  digestant  formula. 

Indications:  Gastro-intestinal  indigestion  with  achlor- 
hydria,  flatulence  and  fermentation.  Wherever  alimentary 
enzyme  medication  is  called  for,  especially  in  atonic  gastric 
insufficiency. 

Remarks:  The  ferments  are  active  and  cooperate  with 
one  another.  No  pepsin  is  present  but  in  its  place  papain 
(so-called  "vegetable  pepsin"  which  is  active  in  either  acid 
or  alkaline  media)  is  used.  Each  package  contains  a  card 
on  whi«h  is  printed  the  following : 

Note:  The  digestive  ferments  in  this  formula  are  de- 
stroyed by  heat  above  110  deg.  F.  It  is  advisable  to  take 
them  some  hours  after  eating,  with  water.  Do  not  take  with 
HOT  foods  or  drinks. 


62  PRACTICAL  ORGANOTHERAPY 

NO.  13.   HEMOGLOBIN  CO. 

ANEMIA;  Chlorosis;  Malnutrition. 

Formula:  Each  six  grains  represents  the  following  com- 
bination: Hemoglobin  (repurified)  gr.  4,  Desiccated  spleen 
parenchyma  gr.  1,  Acid  Nucleinic  (Nuclein)  gr.  1/2  with 
Calcium  Phosphorus  Co.  (Harrower)  q.  s. 

Prescribe  Thus:  I£  Hemoglobin  Co.  (Harrower)  No.  C. 
Sig.  One  before  meals  and  on  retiring.  (Considerably  in- 
creased doses  may  be  given  when  marked  hematinic  effects 
are  needed,  say,  three,  four  times  a  day  for  a  week  or  more.) 

Physiological  Effects:  Purveys  an  acceptable  and  easily 
absorbable  iron  to  the  organism.  Non-constipating.  Stim- 
ulates hematopoiesis.  Encourages  leucocyte  production  and 
phagocytosis. 

Indications:  All  forms  of  anemia,  both  primary  and  secon- 
dary. Malnutrition  due  to  blood  conditions;  convalescence 
from  acute  infectious  diseases,  surgery  and  the  puerperium, 
especially  where  there  has  been  a  considerable  loss  of  blood. 
Cachexia,  cancer  and  chronic  blood-destroying  conditions  in- 
cluding pernicious  anemia.  Where  iron  ordinarily  is  indi- 
cated. 

Remarks:  An  unusually  excellent  combination  which  has 
been  the  means  of  causing  a  number  of  remarkable  changes 
in  the  Hgb.  index  and  blood  picture.  It  should  be  stated 
that  this  or  any  other  form  of  iron  exerts  no  known  influ- 
ence upon  the  blood-cell-destroying  factor  in  pernicious  ane- 
mia. The  French  insist  that  hemoglobin,  in  addition  to  its 
hematinic  virtues,  also  exerts  a  "homostimulant  action"  sim- 
ilar to  the  influence  of  thyroid  extract  upon  thyroid  secre- 
tion, etc.  At  all  events,  it  is  quite  the  best  form  of  iron  for 
oral  administration. 

Reference:    Sec.  V,  Ch.  14. 

NO.  14.    NUCLEO-LECITHIN  CO. 

MALNUTRITION;  Cachexia;  Marasmus;  Rickets,  etc. 

Formula:  Each  dose  contains  seven  and  a  half  grains 
(half  a  gram)  of  the  following  combination:  Lecithin  (90- 
95%)  gr.  21/£,  Acid  Nucleinic  (Nuclein)  gr.  1,  Calcium 
glycerophosphate  and  Calcium  phosphate  (dibasic)  aa  gr.  2. 

Prescribe  Thus:  I£  Nucleo-Lecithin  Co.  (Harrower)  grs. 
viiss,  No.  C.  Sig.  Three  a  day  with  food. 
(Larger  doses  may  be  taken,  say,  up  to  two,  four  times  a 
day.) 


PLURIGLANDULAR  THERAPY  63 

Physiological  Effects:  Each  of  the  ingredients  of  this 
formula  contains  organic  phosphorus  in  easily  assimilable 
form;  in  fact  lecithin  is  stated  to  be  the  richest  and  most 
easily  acceptable  form  of  organic  phosphorus  known.  Each 
dose  contains  a  generous  amount  of  this  product,  as  well  as 
of  nuclein  and  the  glycerophosphate  of  calcium. 

Indications:  Malnutrition,  especially  in  such  chronic  or 
developmental  dystrophies  as  are  known  to  respond  par- 
ticularly to  phosphorus,  including  certain  central  nervous 
disorders,  cachexia,  marasmus  and  rickets.  A  recon- 
structive and  nutritive  nerve  and  cell  tonic. 

Remarks:  Lecithin  is  a  remarkable  remedy  and  for  many 
years  has  been  warmly  recommended  for  a  very  much  longer 
list  of  disorders,  mostly  of  a  chronic  and  nerve  type,  than  is 
mentioned  above.  The  combination  is  as  good  a  phosphorus 
bearing  one  as  the  writer  knows  of,  and  each  individual  ele- 
ment therein  is  generously  dosed. 

Reference:     Sec.  VI,  Ch.  28. 

NO.  15.     SECRETIN  CO. 

INDIGESTION;  Pancreatic  and  Biliary  Insufficiency;  In- 
testinal Toxemia. 

Formula:  Each  five  and  a  half  grains  represents  the  fol- 
lowing combination:  Secretin  extract  (duodenal)  gr.  3, 
Bile  salts  (powdered)  gr.  l1/^,  Adrenal  substance  gr.  14  with 
Calcium  Phosphorus  Co.  (Borrower)  q.  s. 

Prescribe  Thus:  I£  Secretin  Co.  (Harrower)  No.  C.  Sig. 
Two,  between  meals,  t.  i.  d.  It  may  be  well  to  push  the 
dosage  to  3  or  even  4  at  a  time  for  the  first  week  or  10  days 
in  intractable  cases.  In  ordinary  instances  and  to  maintain 
the  effects  for  a  longer  time  in  cases  of  long  standing  1, 
t.  i.  d.  may  suffice. 

Physiological  Effects:  Secretin  stimulates  pancreatic, 
biliary  and  intestinal  glandular  secretion,  and  actually  forms 
a  part  of  the  finished  enzymic  products.  Bile  salts  encour- 
age increased  biliary  production.  Adrenal  substance  is  a 
tonic  to  unstriped  muscle  as  well  as  to  alimentary  activity 
as  a  whole. 

Indications:  Chronic  indigestion  with  toxemia,  stasis, 
constipation  and  the  numerous  direct  and  indirect  re- 
sults thereof.  Hepato-alimentary  insufficiency  with  fetid, 
clay-like  stools.  Pancreatic  insufficiency.  Hypochlorhydria. 

Remarks:  Quite  unlike  the  enzyme  products  commonly 
used  in  various  forms  of  indigestion.  Secretin  is  the  nor- 


64  PRACTICAL  ORGANOTHERAPY 

mal,  physiological  hormone  stimulus  of  practically  all  of  the 
digestive  secretions;  it  has  been  recommended  for  some 
years  as  an  efficient  and  physiological  remedy.  In  the  diges- 
tive crises  in  summer  complaints  of  children  the  contents 
of  one  half  to  one  dose  with  food,  t.  i.  d.,  is  a  useful  dose. 
In  the  digestive  disorders  of  tabes,  pregnancy  and  cancer, 
especially  the  latter,  where  it  will  be  recalled  there  is  prac- 
tically no  HC1  in  the  gastric  secretion — and  HC1  is  the 
natural  excitant  to  secretin  production  in  the  duodenal  mu- 
cosa — this  formula  is  definitely  indicated. 
Reference:  Sec.  V,  Ch.  22,  23,  24. 

NO.  16.    LIQUOR  HYPOPHYSIS  (U.  S.  P.) 

PARTURITION;  Hemorrhage;  Shock;  Stasis  &  Meteorism; 
Enuresis;  Pelyuria;  Epilepsy;  etc.;  etc. 

Formula:  Each  milliliter  of  the  sterile,  standardized 
solution  of  the  active  infundibular  principle  of  the  pituitary 
body,  corresponds  approximately  to  .02  gm.  of  the  fresh 
gland. 

Prescribe  Thus:  ^  Liq.  Hypophysis  (Harrower)  15  mils. 
(l/2  oz.)  (For  physician's  or  hospital  use  only.) 

Physiological  Effects:  Stimulant  of  unstriped  muscle 
including  heart,  intestines,  etc.,  and,  especially,  of  the  preg- 
nant uterus.  Homostimulant  to  the  pituitary.  Regulator 
of  diuresis.  Galactagogue. 

Indications:  As  above  and  outlined  later.  As  discussed 
previously  under  "Pituitary  Body — Posterior  Lobe." 

Dosage:  Hypodermic — Do  not  inject  superficially.  In 
Labor:  Early  (before  dilation  of  the  cervix)  2  minims,  di- 
luted. At  completion  of  dilatation,  5-15  min.  Repeat  in  30 
to  45  minutes,  if  needed.  After  Labor:  Once  daily  for 
2  to  4  days  (antihemorrhagic,  involutant,  intestinal  stimu- 
lant, galactagogue,  diuretic!)  In  Surgery:  8-15  min.  be- 
fore operation,  repeat  (during  long  operations)  after  2 
hours,  otherwise  at  each  of  three  intervals  of  6  to  8 
hours.  (To  prevent  shock,  hemorrhage,  meteorism,  etc.)  In 
Nose  and  Throat  Surgery:  5-15  min.  one  hour  prior  to  ton- 
sillectomy,  etc.  (5-8  min.  in  children)  prevents  hemorrhage 
and  shock.  In  Cardiac  Asthenia  and  Failure :  5-8  min.  daily 
or  more  often.  In  Graves'  Disease :  5-10  min.  twice  daily ; 
later  once  daily  and  still  later  once  every  other  day.  In 
Intestinal  Paresis :  (with  stasis,  alimentary  cramps  and  me- 
teorism) 15  min.,  repeat  in  3  or  4  hours,  if  needed.  In 
Obstipation:  5  min.;  after  2  hours,  10  min.;  after  4  hours 


PLURIGLANDULAR  THERAPY  65 

more,  15  min. ;  after  still  another  4  hours,  15  min.,  if  needed. 
(Give  to  effect.)  In  Enuresis:  5-8  min.  every  other  day  for 
2  weeks ;  double  this  dose  to  adults.  In  Epilepsy :  10-15  min. 
(less  in  children)  daily,  or  every  other  day  for  several 
weeks,  followed  later,  perhaps,  by  15  min.  once  a  week  for 
some  months  in  conjunction  with  Antero-Pituitary  Co. 
(Harrower)  (No.  2,  q.  v.)  In  Diabetes  Insipidus:  10-15 
min.  daily  or  every  other  day  for  8  or  10  doses. 

Oral  Administration.  Twice  the  stated  hypodermic  dose, 
twice  or  three  times  a  day,  in  the  chronic  phases  of  con- 
ditions mentioned  above,  as:  Before  surgery,  in  cardiac 
disease,  Graves'  disease,  alimentary  stasis  and  atony,  enu- 
resis  and  epilepsy.  Useless  per  os  in  labor,  shock,  severe 
obstipation  and  active  conditions  where  immediate  results 
are  necessary. 

Intravenous  Injection.  In  serious  collapse,  cardiac  fail- 
ure, hemorrhage  and  where  the  indicated  hypodermic  use 
is  ineffective,  give  15-30  min.  (1  or  2  mils.)  with  20  mils,  or 
more  of  sterile  saline  solution  into  the  medium  basilic  vein. 
Repeat  in  2  hours,  if  desirable. 

Remarks:  "A  very  wonderful  and  unexcelled  remedy  in 
a  surprisingly  large  and  varied  list  of  disorders." 

The  physiological  efficacy  of  this  preparation  is  rigidly 
standardized  in  harmony  with  the  requirements  of  the  U.  S. 
P.  IX  and  the  recommendations  of  the  Treasury  Depart- 
ment of  the  U.  S.  In  addition  to  careful  checking  in  the 
laboratory,  a  portion  of  each  batch  is  sent  East  for  restand- 
ardization  in  a  prominent  research  laboratory.  It  is  stable, 
sterile  and  standard.  The  vial  package  developed  in  The 
Harrower  Laboratory  favors  rapidity  of  use,  convenience 
in  securing  smaller  or  larger  doses  than  the  usual  ampule 
contents  and,  hence,  economy. 

Instructions:  Remove  vial  from  protecting  box.  Bare 
the  rubber  covering.  Alcoholize  this  and  the  sterile  needle. 
Dry  thoroughly.  Insert  needle  through  rubber.  Invert. 
Withdraw  just  enough  of  the  solution — DO  NOT  RETURN 
ANY  EXCESS.  Replace  cover.  Return  to  container. 

NO.  18.    IODIZED  THYROID  CO. 

GOITRE;  Simple  Thyroid  Enlargement;  Hypothyroidism. 
Formula:  Each  six  grains  represents  the  following  com- 
bination :  Thyroid  gland  (U.  S.  P.  IX) ,  Ferrous  Iodide,  Acid 
Nucleinic  (Nuclein)  aa  gr.  1/4  with  Calcium  Phosphorus 
Co.  q.  s. 

5 


€6  PRACTICAL  ORGANOTHERAPY 

Prescribe  Thus:  ty  Iodized  Thyroid  Co.  (Harrower)  No. 
C.  Sig.  One,  t.  i.  d.  between  meals  with  water.  (Occa- 
sionally it  may  be  best  to  give  four  to  six  a  day  for  a  short 
time.) 

Physiological  Effects.  Replaces  the  deficient  thyroid  hor- 
mone, stimulates  thyroid  secretory  activity.  The  iodine  is 
a  thyroid  stimulant  (food)  and  nucleinic  acid  reenforces  the 
whole  by  furthering  the  immunity  and  leucocytic  functions. 

Indications:  Simple  goitre  or  enlargement  of  the  thyroid 
with  no  evidence  of  thyroidism  (best  to  have  previously 
made  a  Thyroid  Function  Test — see  No.  10 — and  differen- 
tiated between  thyroid  enlargement  due  to  glandular  insuf- 
ficiency and  that  due  to  glandular  irritability) ;  anemia  and 
malnutrition,  especially  in  girls  at  puberty  who  have  slight 
enlargement  of  the  thyroid ;  hypothyroidism  with  or  with- 
out enlargement  of  the  gland. 

Remarks:  Where  thyroid  enlargement  is  due  to  an  at- 
tempt of  the  body  to  meet  certain  unusual  demands  for  the 
thyroid  stimuli,  the  gland  is  enlarged  to  render  the  larger 
service  demanded  of  it.  This  is  also  true  where  there  is  a 
thyroid  cellular  inefficiency  with  the  usual  demands  of  the 
organism  for  its  influence  on  metabolism.  In  girls  at  pu- 
berty and  women  during  the  various  ovarian  changes  there 
often  appears  an  enlargement  of  the  thyroid  which  is  bene- 
fited by  such  treatment  as  is  represented  by  this  special 
formula.  It  serves  the  double  purpose  of  offering  a  suit- 
able dose  of  thyroid  and  a  convenient  form  of  iodine  (which, 
by  the  way,  has  the  added  advantage  of  the  hematinic  value 
of  the  iodide  of  iron)  plus  the  leucocyte  and  resistance- 
stimulating  effect  of  nuclein. 

Reference:  Sec.  IV,  Ch.  4;  Sec.  V,  Ch.  28;  Sec.  VI, 
Ch.  12,  35. 

NO.  22.    BILE  SALTS  CO. 

BILIARY  INSUFFICIENCY;  Mucous  Colitis;  Constipation; 
Intestinal  Indigestion. 

Formula:  Each  dose  represents  three  grains  each  of 
repurified  powdered  bile  salts  and  desiccated  hepatic  sub- 
stance. 

Prescribe  Thus:  I£  Bile  Salts  Co.  (Harrower)  No.  C. 
Sig.  One  q.  i.  d.  between  meals  for  3  days,  then  double  dose 
for  3  more  days,  then  treble  dose  for  3  days,  continue  until 
free  bile  appears  with  stool,  then  reduce  to  3  a  day  for  some 
weeks.  (It  is  well  to  repeat  this  step-ladder  routine 


PLURIGLANDULAR  THERAPY  67 

monthly,  especially  in  old  and  stubborn  cases.)  Note :  It  is 
best  to  give  written  instructions  to  the  patient  direct  as 
the  dose  varies  naturally  with  the  hepato-biliary  response 
and  the  above  routine  is  infinitely  superior  to  the  usual 
method;  therefore  I  suggest  this  direction  to  the  pharma- 
cist: Sig.  Take  increasing  doses  between  meals  as  directed. 

Physiological  Effects:  Hepato-biliary  stimulant,  increas- 
ing both  the  flow  of  the  bile  and  the  general  hepatic  activity 
including  its  detoxicative  functions.  Favors  the  reestab- 
lishing of  normal  conditions  in  muco-membranous  entero- 
colitis. 

Indications:  Functional  liver  insufficiency,  intestinal 
stasis,  sluggish  bile  flow,  gall  stones,  duodenal  indigestion 
and  chronic  nutritional  disorders  such  as  tuberculosis  where 
hepato-biliary  function  is  especially  important.  Mucous 
colitis.  Chronic  hepatic  disease  with  cirrhosis  or  hyper- 
trophy. 

Remarks:   The  clinical  value  of  bile  is  not  appreciated 
enough.    It  is  the  cholagogue  par  excellence.    Hepatic  sub- 
stance has  been  used  for  years  in  France  to  facilitate  the  re-  . 
establishment  of  deficient  liver  activity.    The  above  com- 
bination is  superior  to  either  of  the  ingredients. 

The  proper  dosage  is  "enough."  If  constipation  is  marked 
and  the  patient  is  taking  cathartics,  continue  them  as  be- 
fore. Suggest  the  above  step-ladder  dosage  and  when  free 
bile  is  seen  omit  the  cathartics,  continuing  the  high  dosage 
of  the  Bile  Salts  Co.  (Harrower)  for  two  or  three  days  and 
gradually  reduce  it,  until,  perhaps,  just  2  or  3  are  taken  at 
night.  In  chronic,  toxic  cases  I  recommend  the  repetition  of 
this  routine  several  times  and  the  continuance  of  this  treat- 
ment for  months. 

In  France  Prof.  Roger  insists  that  mucous  colitis  is  largely 
a  disorder  due  to  biliary  sluggishness  and  explains  his  rea- 
sons very  satisfactorily: 

Reference:  Sec.  V,  Ch.  22,  23. 

NO.  23.    PANCREATIN-BILE  CO. 

INTESTINAL  INDIGESTION;  Biliary  Insufficiency;  etc. 

Formula:  Each  dose  represents  two  grains  each  of  Pan- 
creatin  (U.  S.  P.  IX),  Bile  salts  and  Hepatic  substance  (as 
in  No.  22). 

Prescribe  Thus:  B  Pancreatin-Bile  Co.  (Harrower)  No. 
C.  Sig.  Two  an  hour  or  more  after  each  meal.  (Later  this 
may  be  given  in  smaller  doses  or  after  two  main  meals.) 


68  PRACTICAL  ORGANOTHERAPY 

Physiological  Effects:  Digestant,  hepato-biliary  regulator 
and  general  alimentary  secretory  stimulant. 

Indications:  Intestinal  indigestion  with  hepato-biliary 
torpor,  alimentary  toxemia  and  stasis.  Essentially  the  same 
indications  as  suggested  for  No.  22. 

Remarks:  Perhaps  the  addition  of  the  pancreatin  makes 
the  combination  more  suited  for  the  control  of  conditions  in 
which  the  intestinal  rather  than  the  hepatic  element  pre- 
dominates, especially  where  the  stools  are  malodorous  and 
often  light  colored  and  sticky. 

NO.  24.     PARATHYROID  CO. 

PARALYSIS  AGITANS;  Tetany;  Hypoparathyroidism. 

Formula :  Each  five  grains  represents  the  following  com- 
bination: Desiccated  Parathyroid  glands  gr.  1/20,  Sper- 
min  Extract  (from  interstitial  cells  of  Leydig)  gr.  1,  Bile 
salts  (powdered)  gr.  11^  with  Calcium  Phosphorus  Co. 
(Harrower)  q.  s. 

Prescribe  Thus:  ^  Parathyroid  Co.  (Harrower)  No.  C 
Sig.  One,  four  times  a  day  between  meals. 

Physiological  Effects:  Stimulates  the  detoxicative  influ- 
ence of  the  parathyroids  (which  are  said  to  have  the  faculty 
of  destroying  poisons  which  have  a  predilection  for  the 
nervous  system) ;  increases  muscular  tone  and  stimulates 
hepato-biliary  activity. 

Indications:  Parathyroid  insufficiency,  including  certain 
neuro-muscular  disorders  as  paralysis  agitans,  tetany  and 
chorea. 

Remarks:  Parathyroidism  therapy  has  been  frequently 
recommended  in  paralysis  agitans  and  undoubtedly  it  has 
been  helpful  in  many  cases,  but  I  do  not  urge  it  with  the 
enthusiasm  that  I  recommend  many  other  formulas  from 
this  laboratory.  At  least  this  formula  is  superior  to  para- 
thyroid alone  for  two  reasons:  (1)  There  is  a  well-estab- 
lished functional  relation  between  the  liver  and  parathy- 
roids and  in  paralysis  agitans  there  is  invariably  need  for 
hepato-biliary  stimulation,  (2)  the  cellulo-tonic  effect  of 
spermin  is  useful  in  all  cases  of  waning  glandular  activity, 
senility  and  deficient  oxidation. 

The  treatment  must  be  given  for  many  months,  and  it 
would  be  better  not  to  start  than  to  give  a  couple  of  hundred 
5-gr.  doses  alone.  Sometimes  double  the  above  dosage  for 
one  out  of  every  three  weeks  is  an,  advantage. 

Reference:    Sec.  IV,  Ch.  10;  Sec.  VI,  Ch.  30. 


PLURIGLANDULAR  THERAPY  69 

NO.  26.    ADRENO-HYPOPHYSIS  CO. 

ASTHMA;  Bronchial  Asthma. 

Formula:  Each  five  grains  represents  the  following  com- 
bination :  Adrenal  substance  (total)  gr.  i/2»  Pituitary  gland 
(anterior  lobe)  gr.  2,  Calcium  Lactate  and  Calcium  Phos- 
phate (dibasic)  aa  q.  s. 

Prescribe  Thus:  ^  Adreno-Hypophysis  Co.  (Harrower) 
No.  C.  Sig.  One  q.  i.  d.  before  meals  and  at  bedtime.  (Occa- 
sionally a  larger  dose  may  be  given,  say,  one  every  three 
hours  or  two,  t.  i.  d.) 

Physiological  Effects:  Antagonizes  asthenia  and  hypo- 
adrenia;  is  said  to  exert  a  beneficial  effect  (both  because  of 
the  adrenal,  pituitary  and  calcium  content)  on  bronchial 
asthma  and  allied  conditions. 

Indications:  Asthma  and  bronchial  asthma  in  children 
and  adults,  especially  where  there  may  be  an  underlying 
endocrine  element  present. 

Remarks:  This  formula  is  still  purely  experimental.  It 
has  prospects  of  real  value.  The  dosage  suggested  is  innoc- 
uous and  is  not  known  to  cause  unpleasant  reactions.  Such 
a  preparation  cannot  take  the  place  of  antispasmodic  reme- 
dies like  morphin  or  adrenalin,  which  may  have  to  be  used 
simultaneously.  This  remedy,  however,  may  make  some 
favorable  modification  of  the  underlying  cause  of  the 
asthma.  It  is  at  least  worth  trying  in  suitable  cases,  in 
conjunction  with  other  indicated  measures. 

Reference:    Sec.  V,  Ch.  16,  26. 

NO.  29.  THYRO-PANCREAS  CO.  with  SPERMIN 
NO.  30.    THYRO-PANCREAS  CO.  with  OVARY 

FUNCTIONAL  HYPERTENSION 

Formulas:  Each  five  grains  represents  the  following  com- 
binations: Pancreas  gland  (total)  gr.  2,  Thyroid  gland 
(U.  S.  P.)  gr.  1/12,  Spermin  extract  (or  Ovarian  substance, 
respectively)  gr.  2  with  Calcium  Phosphorus  Co.  (Har- 
rower) q.  s. 

Prescribe  Thus:  ^  Thyro-Pancreas  Co.w.  Spermin  (or 
Ovary)  (Harrower)  No.  C.  Sig.  One  q.  i.  d.,  at  meals  and 
bedtime. 

Physiological  Effects:  Antagonist  to  adrenal  irritability 
and  functional  irritation  of  blood-pressure  regulating  me- 
chanism, stimulant  of  oxidation  and  regulator  of  gonad  func- 
tion. In  the  male  the  spermin  acts  by  stimulating  cell  activ- 


70  PRACTICAL  ORGANOTHERAPY 

ity,  while  in  the  female  the  ovarian  substance  is  helpful  by 
regulating  ovarian  endocrine  function,  especially  at  or  after 
the  menopause. 

Indications :  High  blood-pressure  where  it  is  evident  that 
the  sole  cause  is  not  renal,  cardiac  or  vascular  (arterio- 
sclerosis) . 

Remarks:  Numerous  clinical  tests  checked  by  careful 
sphygmomanometry  have  proved  that  the  use  of  these  for- 
mulas does  reduce  functionally  high  tensions.  In  organic 
hypertension  there  may  be  a  functional  element  as  well  as 
the  structural  change.  Here  this  treatment  may  be  given 
with  the  prospect  of  causing  some  slight  reduction  in  that 
part  of  the  tension  which  may  be  functional.  If  it  is  given 
for  a  month  or  six  weeks  with  no  measurable  benefit,  it  is 
not  likely  that  it  would  be  beneficial  to  continue  its  use. 

References:    Sec.  V,  Ch.  15;  Sec.  VI,  Ch.  34. 

NO.  38.    MAMMA-OVARY  CO. 

DYSOVARISM;  Menorrhagia;  Prolonged  Menses. 

Formula:  Each  five  grains  represents  the  following  com- 
bination: Mammary  substance  gr.  2^,  Ovarian  substance 
gr.  1,  Thyroid  gland  gr.  y%  with  Calcium  Phosphorus  Co. 
(Harrower)  q.  s. 

Prescribe  Thus:  ^  Mamma-Ovary  Co.  (Harrower)  No. 
C.  Sig.  One  t.  i.  d.,  a.  c.,  double  3  days  before  and  during 
menses,  omit  for  one  week.  Repeat. 

Physiological  Effects:  Ovarian  regulator,  antagonist  to 
excessive  ovarian  endocrine  function. 

Indications:  Moderate  menorrhagia  with  or  without  dys- 
menorrhea;  difficult  menstrual  onset;  too  frequent  menses 
or  prolonged  menses;  dysovarism  with  a  tendency  to  ova- 
rian irritability  and  pelvic  congestion.  Used  in  preference 
to  No.  40  (q.  v.)  in  girls  and  young  women  with  function- 
ally hyperactive  ovaries  with  an  excessive  or  prolonged 
flow,  etc. 

Remarks:  The  best  results  from  this  formula  are  obtained 
when  it  is  pushed  just  before  and  during  the  flow.  In  dis- 
turbed ovarian  functioning  sometimes  this  formula  may  be 
alternated  with  Thyro-Ovarian  Co.  (Harrower)  or  may 
replace  it  in  ovaro-uterine  conditions  which  lean  toward 
menorrhagia  in  which  the  results  from  this  latter  formula 
leave  something  to  be  desired. 

Reference:  Sec.  IV,  Ch.  8;  Sec.  V,  Ch.  9;  Sec.  VI, 
Ch.  8,  10. 


PLURIGLANDULAR   THERAPY  71 

NO.  40.    MAMMA-PITUITARY  CO. 

MENORRHAGIA;  Metrorrhagia;  Uterine  Subin volution ; 
Fibroids;  etc. 

Formula:  Each  five  grains  represents  the  following  com- 
bination: Mammary  substance  gr.  21/2,  Ergotin  (Bonjean) 
gr.  y%,  Pituitary  gland  (total)  gr.  14  with  Calcium  Phos- 
phorus Co.  (Harrower)  q.  s. 

Prescribe  Thus:  ty  Mamma-Pituitary  Co.  (Harrower) 
No.  C.  Sig.  One,  t.i.d.,  a.c.,  double  3  days  before  and  during 
flow,  omit  for  one  week.  Repeat.  (Occasionally  more  may 
be  given  during  the  heaviest  part  of  the  flow,  say,  2  every 
three  hours.) 

Physiological  Effects:  Antagonist  to  ovarian  endocrine 
function;  uterine  muscular  tonic;  uterine  circulatory  de- 
pletant. 

Indications :  Menorrhagia,  metrorrhagia  and  prolonged  or 
excessive  menstrual  or  climacteric  uterine  hemorrhages. 
Uterine  fibroids. 

Remarks:  The  above  formula  has  been  used  with  benefit 
in  organic  uterine  disease,  seemingly  permanent  in  fibro- 
mata and  temporary  in  cancer.  The  chief  benefit  is  shown 
by  the  controlled  bleeding,  though  quite  often  a  fibroid  will 
be  materially  reduced  in  size.  When  given  for  the  uterine 
oozing  of  cancer,  an  explanation  should  be  made  that  the 
expected  benefit  is  symptomatic.  In  menorrhagia  of  ova- 
rian origin  this  is  not  merely  a  symptomatic  regulator  of 
the  excessive  flow,  but  it  is  simultaneously  modifying  the 
underlying  conditions  responsible  for  the  hemorrhage. 

Reference:     Sec.  V,  Ch.  9;  Sec.  VI,  Ch.  8,  10. 

NO.  41.     LEYDIG  CELL  CO. 

PROSTATIC  HYPERTROPHY;  Impotence;  Hypogonad- 
ism. 

Formula:  Each  five  grains  represents  the  following  com- 
bination: Spermin  extract  (from  the  interstitial  cells  of 
Leydig)  gr.  2i/2,  Thyroid  gland  (U.  S.  P.)  gr.  1/16  with 
Calcium  Glycerophosphate  and  Calcium  Phosphorus  Co.  aa 
q.  s. 

Prescribe  Thus:  Tfy  Leydig  Cell  Co.  (Harrower)  No.  C. 
Sig.  One  q.i.d.,  a.c. 

Physiological  Effects :  Homostimulant  of  gonads  and  the 
essential  endocrine  function  of  these  glands;  antagonist  to 
functional  prostatic  hypertrophy.  Cell  stimulant  in  impo- 
tence and  senility. 


72  PRACTICAL  ORGANOTHERAPY 

Indications:  Prostatic  hypertrophy  not  due  to  present 
infection  or  adenoma;  prostatic  hyperesthesia;  asthenia  of 
gpnad  origin;  impotence  and  deficient  gonad  function;  se- 
nility. 

Remarks:  Originally  prepared  for  the  experimental  con- 
trol of  simple  prostatic  hypertrophy  on  the  assumption  that 
when  gonad  function  is  on  the  wane  the  prostate  may  take 
up  certain  of  its  endocrine  functions  vicariously  and  become 
enlarged  in  a  compensatory  fashion.  Results  seem  to  have 
established  its  value,  reduced  prostatic  hyperesthesia,  les- 
sened micturition  and  a  general  feeling  of  well-being  hay- 
ing followed  the  use  of  the  formula  for  a  month  or  six 
weeks. 

Reference:     Sec.  V,  Ch.  20;  Sec.  VI,  Ch.  11. 

NO.  43.    LYMPHATIC  CO. 

LYMPH ATISM;  Hemophilia;  Malnutrition;  etc. 

Formula:  Each  six  grains  represents  the  following  com- 
bination: Desiccated  lymphatic  glands  gr.  2,  Spleen  sub- 
stance gr.  li/2,  Thyroid  gland  (U.  S.  P.)  gr.  1/16  with  Cal- 
cium lactate  q.s. 

Prescribe  Thus:  I£  Lymphatic  Co.  (Harrower)  No.  C. 
Sig.  Two,  with  food,  t.i.d.  Dose  may  be  reduced  after  10 
days  or  more;  and  should  be  continued  for  fully  a  month. 

Physiological  Effects:  Alterative  and  reconstructant  in 
lymphatic  conditions ;  stimulant  of  the  coagulative  capacity 
of  the  blood;  cellular  constructant. 

Indications:  Badly  nourished,  anemic  children  with  a 
tendency  toward  hemorrhage,  especially  in  those  with  large 
and  recurrent  adenoids,  hypertrophied  tonsils,  etc.  Certain 
forms  of  hyperthyroidism,  with  or  without  additional  doses 
of  thyroid  gland.  Lymphatic  enlargement. 

Remarks:  Used  chiefly  for  children,  though  not  contrain- 
dicated  in  adults  of  the  lymphatic,  "bleeder"  type.  May  be 
given  to  such  for  a  week  or  more  before  an  anticipated 
operation  (give  an  injection  of  Liq.  Hypophysis  U.  S.  P. 
— Harrower — half  an  hour  before  operation,  also.) 

NO.  47.   PITUITARY  CO. 

HYPOPITUITARISM;  Infantilism;  Hypogonadism. 

Formula:  Each  dose  represents  Pituitary  gland  (total), 
and  Pituitary  gland  (anterior  lobe)  aa  gr.  li/g  with  Calcium 
Phosphorus  Co.  q.  s. 

Prescribe  Thus:    ^   Pituitary   Co.  (Harrower)    No.   C. 


PLURIGLANDULAR  THERAPY  73 

Sig.  One  q.  i.  d.,  a.  c. 

Physiological  Effects:  Stimulates  carbohydrate  metabol- 
ism; increases  cellular  growth  and  encourages  gonad  func- 
tion, especially  in  essential  pituitary  dysfunction. 

Indications:  The  adipose-genital  syndrome  of  Frohlich; 
hypopituitarism ;  infantilism;  eunuchoidism ;  maldevelop- 
ment  of  gonads  (hypogonadism) ;  developmental  dystrophies 
of  pituitary  origin. 

Remarks:  Contains  a  greater  proportion  of  the  active 
glandular  portion  of  the  pituitary  gland  (the  anterior  lobe) 
than  pituitary  gland  alone,  hence  is  more  useful  in  hypo- 
pituitarism, which  is  essentially  an  anterior  lobe  disease, 
than  total  gland  products.  Above  figures  refer  to  finished 
desiccated  gland,  and  not  to  fresh  substance. 

NO.  48.    PROSTATE  CO. 

PROSTATIC  DISEASE;  Prostatic  Neurasthenia;  Hyper- 
trophied  Prostate;  etc. 

Formula:  Each  six  grains  represents  the  following  com- 
bination: Prostate  gland  (desiccated),  Spermin  extract 
(from  interstitial  cells  of  Leydig)  and  Lymphatic  glands,  aa 
gr.  l!/2»  Acid  Nucleinic  gr.  i/s  with  Calcium  Phosphorus  Co. 
(Harroiver)  q.  s. 

Prescribe  Thus:  I?  Prostate  Co.  (Harrower)  No.  C.  Sig. 
One  t.  i.  d.,  a.  c.  (Occasionally  considerable  increases  in  this 
dosage  are  helpful.  It  is  also  advisable  to  continue  the  treat- 
ment for  several  months,  in  which  case  I  suggest  its  omis- 
sion every  fifth  week.) 

Physiological  Effects:  Homostimulant  to  prostate  and  sex 
glands;  antagonist  to  prostatic  irritability. 

Indications:  Latent  prostatic  insufficiency  with  or  with- 
out an  old  posterior  urethral  or  prostatic  infection;  pros- 
tatorrhea;  endocrine  insufficiency  of  the  gonads  with  impo- 
tence, relative  or  actual.  Prostatic  hypertrophy.  Prostatic 
neurasthenia  and  following  prostatectomy.  Senility. 

Remarks:  Of  similar  character  to  No.  70,  Gonad  Co. 
(Harrower)  q.  v. 

Reference:    Sec.  V,  Ch.  4,  20;  Sec.  VI,  Ch.  2. 

NO.  49.    PLACENTA  CO. 

VOMITING  OF  PREGNANCY;  Nausea  of  Pregnancy;  Pla- 

cental  Toxemia. 

Formula:  Each  six  grains  represents  the  following  com- 
bination: Placental  parenchyma  (desiccated)  gr.  5,  Thy- 


74  PRACTICAL  ORGANOTHERAPY 

roid  gland  (U.  S.  P.)  gr.  1/24  with  Calcium  Phosphorus  Co. 
(Harrower)  q.  s. 

Prescribe  Thus:  J$>  Placenta  Co.  (Harrower)  No.  L.  Sig. 
Two  with  charged  water  or  ice,  q.  i.  d. 

Physiological  Effects:  Antagonizes  placental  toxemia  and 
sedates  hyperemesis  gravidarum.  Presumed  to  act  by  arti- 
ficially establishing  an  immunity  to  the  placental  protein 
poisons  to  which  certain  individuals  are  unusually  sensitive. 

Indications:    Vomiting  and  nausea  of  pregnancy. 

Remarks:  Often  a  last  resort  remedy  of  unusual 
efficacy  when  all  other  treatment  has  failed.  Give  by  mouth 
with  or  without  sedative  medication.  Morphin  has  been 
necessary  to  allow  absorption.  Give  at  times  and  under  cir- 
cumstances which  will  favor  retention.  Twenty-five  grains 
a  day  for  ten  days,  is  usually  a  complete  treatment  since  the 
expected  results  will  come  before  this  time  if  the  measure 
is  going  to  be  efficacious.  Continue  for  a  longer  time  if 
evident  benefit  has  been  initiated. 

Reference:    Sec.  VI,  Ch.  6,  7,  27. 

NO.  57.    THYMUS-SPERMIN  CO. 

ARTHRITIS;  Arthritis  Deformans;  Chronic  Rheumatism; 
Asthenia. 

Formula :  Each  six  grains  represents  the  following  com- 
bination: Adreno-Spermin  Co.  (Harrower)  and  Thymus 
gland  aa.  gr.  3. 

Prescribe  Thus:  1$  Thymus-Spermin  Co.  (Harrower)  No. 
C.  Sig.  One,  q.  i.  d.,  p.  c.  (Occasionally  given  in  larger 
doses  for  a  few  weeks,  then  reduced  to  the  above.) 

Physiological  Effects:  Stimulates  metabolism,  antag- 
onizes adrenal  apathy  and  asthenia.  (See  No.  1  Adreno- 
Spermin  Co. — Harrower) .  According  to  Nathan  and  others 
desiccated  thymus  is  effective  in  certain  chronic  arthrites, 
including  arthritis  deformans. 

Indications:  Chronic  arthritis  or  rheumatism  with  poor 
metabolism  and  deficient  cellular  elimination.  Arthritis  de- 
formans. 

Remarks:  Each  of  the  ingredients  of  this  formula,  the 
Adreno-Spermin  Co.  (Harrower)  and  desiccated  thymus 
have  rendered  service  in  arthritis  deformans.  In  many 
cases  the  prospects  for  results  are  not  bright,  though  this 
treatment  has  been  used  without  hope  and  as  a  last  resort 
with  results  which  were  a  pleasant  surprise  to  all  concerned. 
It  must  be  given  persistently.  It  may  be  well  to  modify 


PLURIGLANDULAR  THERAPY  75 

the  dosage  by  starting  with  the  routine  dosage  suggested 
above,  for  a  month,  then  omit  one  week  and  then  take  2, 
q.  i.  d.  for  a  month,  then  omit  for  a  full  month,  then  repeat 
this  routine,  taking  note  of  any  slight  changes  during  these 
different  periods.  Only  a  part  of  the  routine  treatment. 
Reference:  Sec.  V,  Ch.  18. 

NO.  68.    SPERMIN-HEMOGLOBIN  CO. 

ASTHENIC  ANEMIA;  Hypoadrenia;  Malnutrition. 

Formula :  Each  six  grains  represents  the  following  com- 
bination: Adreno-Spermin  Co/  (Narrower)  (Stock  Formula 
No.  1,  q.  v.)  and  Repurified  Hemoglobin,  aa  gr.  3. 

Prescribe  Thus :  ^  Spermin-Hemoglobin  Co.  (Harrower) 
No.  C.  Sig.  One,  q.  i.  d.,  a.  c. 

Physiological  Effects:  Support  to  depleted  adrenal  func- 
tion. Increases  sympathetic  tone,  increases  oxidation  and 
"dynamos"  (see  Formula  No.  1).  Hematinic  reconstructant. 

Indications:  Conditions  of  asthenia  due  to  hypoadrenia 
with  which  anemia  and  malnutrition  are  present.  Low  blood- 
pressure  with  anemia.  Following  operations  and  experiences 
which  have  depleted  both  the  adrenal  function  and  the 
blood. 

Remarks:  This  formula  is  essentially  the  Adreno-Sper- 
min formula  to  which  attention  has  already  been  called, 
plus  the  effective  hematinic,  hemoglobin.  Spermin-Hemo- 
globin Co.  (Harrower)  takes  the  place  of  the  combined 
administration  of  No.  1  (Adreno-Spermin  Co.)  and  No. 
13  (Hemoglobin  Co.) ,  to  which  attention  has  already  been 
called. 

Reference:     Sec.  V,  Ch.  14. 

No.  70.    GONAD  CO. 

IMPOTENCE;  Asexualism;  Hypogonadism. 

Formula:  Each  six  grains  represents  the  following  com- 
bination: Adrenal  gland  (total)  gr.  1/4,  Thyroid  gland 
(U.  S.  P.)  gr.  1/12,  Pituitary  gland  (anterior  lobe)  gr.  1, 
Prostate  gland  and  Spermin  extract  (from  Leydig  cells)  aa 
gr.  l!/2  with  Calcium  Phosphorus  Co.  (Harrower) ,  q.  s. 

Prescribe  Thus:  I£  Gonad  Co.  (Harrower)  No.  C.  Sig. 
One  q.  i.  d.,  a.  c.  (Note:  From  3  to  8  may  be  given  daily.) 

Physiological  Effects:  General  cell  stimulant,  especially 
of  the  essential  sex  glands  through  the  pituitary,  adrenals, 
thyroid  and  gonads  themselves.  The  addition  of  the  anterior 
pituitary  seems  to  be  especially  helpful  (recall  that  the  dys- 


76  PRACTICAL  ORGANOTHERAPY 

trophia  adiposo-genitalis — hypopituitarism — is  a  functional 
genital  disorder  which  has  been  benefited  by  suitable  or- 
ganotherapy) .  Antagonizes  asthenia.  Stimulates  prostato- 
gonad  function  on  the  principle  of  homostimulation. 

Indications:  Functional  and  endocrine  impotence;  asex- 
ualism  both  organic  and  acquired ;  senility ;  presenility ;  hy- 
pogonadism ;  sexual  neurasthenia ;  aspermia ;  sterility. 

Remarks:  Best  given  in  step-ladder  dosage,  as  1,  t.i.d. 
for  several  weeks,  then  2,  t.i.d.  for  a  longer  period,  followed, 
if  necessary,  by  another  period  when  even  3,  t.i.d.  may  be 
taken.  Given  in  conjunction  with  associated  treatment. 
Has  no  effect  upon  conditions  with  a  psychic  basis,  nor  does 
it  influence  latent  infections.  Not  rapid  in  its  action,  there- 
fore unusual  caution  must  be  taken  to  urge  protracted  use 
or  not  to  start  it. 

Reference:     Sec.  V,  Ch.  20,  21. 

No.  73.    GONAD-OVARIAN  CO. 

STERILITY;  Hypo-ovarism ;  Asexualism;  Infantilism; 
Amenorrhea. 

Formula:  Each  six  grains  represents  the  following  com- 
bination: Thyro-Ovarian  Co.  (Harrower)  (No.  4,  q.  v.)  gr. 
3,  Spermin  extract  and  pituitary  gland  (anterior  lobe)  aa 
gr.  H/2. 

Prescribe  Thus:  I£  Gonad-Ovarian  Co.  (Harrower)  No. 
C.  Sig.  One  q.  i.  d.,  a.  c.  If  the  patient  is  menstruating  or 
there  is  a  molimen,  prescribe  as  formula  No.  4,  i.  e.,  1,  t.i.d., 
a.  c.  for  10  days,  double  dose  for  7  to  10  days  before  menses 
(or  molimen) ,  omit  at  onset  of  menses  for  a  week.  Repeat. 

Physiological  Effects:  Ovarian  stimulant  through  the 
endocrine  function  of  the  ovaries  plus  the  gonado-stimulant 
effect  of  the  anterior  pituitary  and  the  general  sex  and  cell 
stimulant  effect  of  spermin  from  the  male  gonads. 

Indications:  Prolonged  amenorrhea;  infantilism;  sex 
mal-development  and  hypof unction ;  lack  of  libido ;  endocrine 
sterility;  and,  in  general,  the  same  indications  as  Thyro- 
Ovarian  Co.  (Harrower)  (q.  v.)  save  that  the  condition  is 
more  decisive  and  marked.  Where  the  use  of  this  latter  has 
not  been  sufficiently  stimulating  enough. 

Remarks:  Endocrine  stimulation  through  all  of  the 
glands  involved  in  "the  sex  complex"  is  about  the  only 
physiological  hope  in  many  cases  of  essential  amenorrhea 
and  sexual  apathy  in  the  woman.  The  cyclic  method  is  bet- 
ter if  it  can  be  applied.  Here,  also,  the  gland  feeding  must 


PLURIGLANDULAR  THERAPY  77 

be  continued  with  persistence  for  long  periods  because  the 
attempt  is  being  made  to  reeducate  certain  endocrine  func- 
tions, which  naturally  takes  months  and,  further,  the  time 
that  the  ovaries  are  especially  stimulable  only  lasts  a  com- 
paratively short  time  each  month. 

Reference:    Sec.  IV,  Ch.  8 ;  Sec.  V,  Ch.  6,  7. 

No.  79.    ADRENO-OVARIAN  CO. 

DYSOVARISM  with  Hypoadrenia. 

Formula:  Each  dose  represents  five  grains  of  the  Thyro- 
Ovarian  Co.  (Harrower)  with  Adrenal  substance  (total) 

ST.  l/4. 

Prescribe  Thus:  ^  Adreno-Ovarian  Co.  (Harrower)  No. 
C.  Sig.  One,  t.  i.  d.  for  10  days,  double  dose  for  7  to  10 
days  before  menses,  omit  at  onset  for  10  days.  Repeat. 

Physiological  Effects:  Ovaro-uterine  regulator  through 
the  ovarian  hormone  function,  plus  adrenal  support. 

Indications:  Ovarian  dysfunction,  amenorrhea,  dysmen- 
orrhea  and,  generally  conditions  in  which  the  Thyro- 
Ovarian  Co.  (Harrower)  would  be  used  (see  No.  4)  with 
hypoadrenia  and  asthenia,  low  blood-pressure  and  general 
cellular  apathy. 

Remarks:  Supplements  the  well-known  Thyro-Ovarian 
formula  with  adrenal  support  and  obviates  the  occasional 
necessity  for  prescribing  Adreno-Spermin  Co.  (Harrower) 
with  the  ovarian  treatment.  Especially  helpful  in  pallid, 
asthenic  girls  and  young  women  with  ovarian  insufficiency, 
amenorrhea,  etc.  Also  indicated  in  the  climacteric  when  the 
dysovarism  is  complicated  with  an  aggravated  fatigue  syn- 
drome, etc. 

Reference:  Sec.  IV,  Ch.  8;  Sec.  V,  Ch.  5,  6,  7;  Sec.  VI, 
Ch.  3,  12,  17. 

No.  85.    CAPS.  RENAL  CO. 

NEPHRITIS;  Albuminuria;  Renal  Insufficiency. 

Formula:  Each  dose  represents  desiccated  renal  glomer- 
ular  tissue  and  desiccated  pancreas  gland,  aa  gr.  2y%. 

Prescribe  Thus:  IJ  Renal  Co.  (Harrower)  No.  C.  Sig. 
One,  q.  i.  d.,  a.  c. 

Physiological  Effects:  Tends  to  reduce  renal  imperme- 
ability; lessens  albumin  elimination  through  the  glomeruli; 
stimulates  renal  efficacy;  encourages  pancreatic  and  intes- 
tinal physiology. 


78  PRACTICAL  ORGANOTHERAPY 

Indications:  Acute  and  chronic  Bright's  disease  with  or 
without  albuminuria;  essential  albuminuria  without  other 
renal  (or  local)  findings;  deficient  renal  activity  with  poly- 
uria  and  low  total  solids. 

Remarks:  For  years  renal  glomerular  substance  has  been 
recommended,  especially  in  France,  for  nephritis  and  albu- 
minuria. Various  explanations  have  been  given  as  to  why 
it  is  useful.  Suffice  it  to  say  that  many  times  it  has  reduced 
the  urinary  difficulties,  both  clinical  and  laboratory,  of 
various  forms  of  nephritis.  The  addition  of  pancreas  gland 
is  rational,  for  it  tends  to  reduce  the  very  conditions  which 
are  aggravating  to  the  renal  cells,  as  well  as  to  neutralize 
the  adrenal  irritability  so  usual  in  such  cases. 

Reference:    Sec.  V,  Ch.  26. 


SECTION  IV 

THE  DIAGNOSIS  OF  THE  INTERNAL  SECRETORY 

DISORDERS 


There  is  no  convenient  source  of  information  on  this  sub- 
ject. Among  the  several  books  on  endocrinology — notably 
Sajous,  Biedl,  Falta-Myers,  Carnot  and  Pende  the  whole 
subject  is  considered,  but  chiefly  from  the  standpoint  of  the 
well-defined,  structural  endocrine  disorders.  To  my  own 
way  of  thinking  the  functional  endocrinopathies  far  out- 
weigh in  importance  the  text-book  diseases  of  this  character 
because  they  are  so  much  more  frequent,  and  so  much  more 
routinely  overlooked. 

This  section  contains  a  large  amount  of  data  on  the  diag- 
nostics of  endocrine  disorders  in  general  practice,  and  is  not 
intended  to  be  either  complete  or  technical,  but  rather  to 
serve  as  a  means  of  reminding  the  reader — presumably  "an 
ordinary  doctor"  like  myself — of  some  points  which  may  be 
really  helpful  in  the  day's  work. 

SECTION  IV.    CHAPTER  1 

THE  FREQUENCY  OF  INTERNAL  SECRETORY  DIS- 
ORDERS IN  GENERAL  PRACTICE 


The  insidiousness  and  practical  importance  of  disturbed 
function  of  the  glands  of  internal  secretion  is  far  greater 
than  most  physicians  realize ;  and  the  frequency  with  which 
it  may  be  encountered  in  almost  every  phase  of  general  as 
well  as  special  practice,  coupled  with  the  fact  that  many 
times  it  is  entirely  overlooked,  constitute  the  occasion  for 
this  section  on  endocrine  diagnosis. 

The  Broad  Influence  of  the  Hormones.  Increasing  atten- 
tion is  being  paid  to  the  study  of  the  glands  of  internal  secre- 
tion, or  endocrine  organs,  as  we  shall  call  them,  and  rightly 
so.  Our  knowledge  of  the  physiological  action  of  these 
organs  has  been  acquired  almost  entirely  in  the  last  fifty 
years ;  and  has  been  augmented  very  materially  in  the  past 
15  or  20  years.  In  fact,  practically  all  we  know  of  the  inter- 
nal secretions  has  been  learned  in  this  brief  period  and  the 
establishment  of  the  fundamental  contentions  of  the  now 

79 


80  PRACTICAL  ORGANOTHERAPY 

famous  French  scientist,  Claude  Bernard  and  Brown- 
Sequard,  were  not  accomplished  and  their  experiences  scien- 
tifically explained  until  as  recently  as  1902,  when  Professor 
E.  H.  Starling,  of  University  College,  London,  suggested  the 
term  "hormone"  (from  the  Greek  word  which  means  "I 
arouse"  or  "I  set  in  motion")  to  designate  a  class  of  chemical 
substances,  of  which  his  newly  discovered  secretin  was  the 
type  (see  Sec.  V,  Chap.  15).  These  hormones  are  produced 
in  various  parts  of  the  body  and  are  carried  by  the  blood  or 
other  body  fluids  to  various  more  or  less  remote  organs 
where  they  excite  certain  physiological  manifestations,  thus 
correlating  the  functions  of  numerous  and  widely  separated 
organs. 

The  subject  is  of  much  more  than  academic  importance 
for  as  an  editorial  writer  in  the  New  York  Medical  Journal 
(Feb.  26,  1916,  p.  412)  remarks:  "Treatment  based  on  the 
internal  secretions,  is  in  some  instances,  positively  start- 
ling in  its  results,  and  bids  fair  to  revolutionize  our  methods 
in  several  lines  of  practice;  it  is  also  eminent^  satisfying 
from  a  scientific  viewpoint,  being  far  removed  from  our  old 
hesitating  empiricism." 

The  endocrine  glands,  then,  are  factors  of  no  mean  im- 
port in  the  maintenance  of  that  balance  of  activities  which 
we  call  "health,"  and  hence  are  worthy  of  more  careful  study 
and  practical  consideration  in  our  clinical  work.  These  or- 
gans and  their  hormones  play  a  much  more  vital  part  than 
many  physicians  have  allowed  themselves  to  think.  Varia- 
tions in  the  activities  of  these  organs  deserve  the  closest 
attention,  for  too  often  endocrine  disorder  is  only  thought  of 
when  there  is  obvious  disease  of  one  or  more  of  these  glands. 
Since  they  are  now  definitely  known  to  control  growth  and 
development,  regulate  metabolism  and  dominate  the  ner- 
vous system,  more  especially  the  sympathetic  or  autono- 
mous system,  their  widespread  activities  assume  a  greater 
importance  for  it  is  quite  clear  that  these  hormones  are 
altogether  indispensable  to  the  maintenance  of  the  physio- 
logical harmony  of  the  functions  of  the  body,  and,  even, 
of  life  itself. 

The  Minor  Glandular  Disorders.  Too  often  we  are  prone 
to  look  upon  this  class  of  disorders  as  rare  and  occasional 
and  their  diagnosis  as  comparatively  easy  because  of  the 
obviousness  of  such  well  marked  diseases  as  cretinism, 
myxedema,  giantism  or  acromegaly.  This  is  a  mistake,  for 
functional  disorders  of  this  class  are  of  everyday  occur- 
rence and  are  naturally  far  more  important  than  the  more 


FREQUENCY  OF  ENDOCRINE  DISORDERS  81 

obvious  organic  diseases,  for  they  are  still  in  their  earliest 
stages  before  serious  disharmony  has  been  caused;  and, 
of  course,  are  more  responsive  to  suitable  treatment. 

Such  all-essential  factors  in  the  regulation  of  human 
chemistry  should  be  of  interest  to  every  general  practitioner 
in  his  investigation  of  every  condition  in  which  disordered 
function  is  present.  We  should  not  be  satisfied  to  know 
how  to  diagnose  and  treat  those  cases  of  definite  endocrine 
disease  merely,  but  rather  should  we  be  always  on  the  look- 
out to  detect  and  understand  the  importance  of  the  insig- 
nificant and  minor  aberrations  from  the  normal,  for  in  so 
doing  in  many  a  case  we  may  be  able  to  forestall  the  more 
serious  and  more  obvious  diseases  which,  if  left  alone,  may 
later  assert  themselves. 

Personal  interest,  no  less  than  the  altruism  of  our  pro- 
fession, demands  that  we  take  first  rank  in  these  matters, 
for  how  can  the  true  family  doctor  bind  a  household  to 
himself  more  surely  than  by  pointing  out  for  correction 
some  endocrine  dystrophy  of  a  child  even  before  the  fond 
parents  have  recognized  the  danger? 

As  the  larger  functions  of  the  internal  secretions  are  be- 
ing appreciated,  their  influence  both  for  good  and  for  bad 
is  seen  to  extend  far  beyond  the  expected  limits  of  definite 
endocrine  disease,  for  as  one  writer  has  aptly  put  it :  "There 
are  a  number  and  variety  of  conditions  which  can  be  under- 
stood and  properly  treated  only  after  full  comprehension 
of  the  work  of  the  endocrine  glands."  All  the  uncounted 
clinical  and  experimental  experiences  which  have  been 
directed  towards  the  solution  of  the  numerous  problems 
which  this  ever-broadening  subject  has  opened  up,  have 
convincingly  demonstrated  that  the  influence  of  the  various 
units  of  the  endocrine  system,  as  well  as  of  the  body  as  a 
whole,  is  far  more  extensive  and  complex  than  even  the 
best  posted  physiologists  had  supposed,  and  that  many 
phenomena  credited  to  nervous  or  sympathetic  nervous  in- 
fluences were  really  the  result  of  hormonic  disharmony. 
In  fact  we  know  as  a  result  of  the  painstaking  work  of  Can- 
non, Crile,  Elliott  and  Sergent,  that  as  the  sympathetic  sys- 
tem is  under  the  direct  control  of  one  or  more  of  these  hor- 
mone influences,  disorders  with  prominent  sympathetic  dis- 
turbances, as  shock,  collapse,  hysteria  and  other  neuroses, 
may  be  traced  further  back  than  we  have  been  in  the  habit 
of  doing  heretofore,  and,  what  is  of  far  greater  practical 
importance,  may  be  controlled  by  applying  the  principles 
which  the  study  of  this  subject  simultaneously  has  proved 


32  PRACTICAL  ORGANOTHERAPY 

possible  in  the  domain  of  therapeutics.  Crile's  exhaustive 
study  of  the  kinetic  system — the  adrenals,  thyroid,  brain 
and  muscles — and  its  practical  application  in  what  he 
chooses  to  call  "anoci-association,"  is  but  one  of  the  many 
profitable  phases  of  this  huge  subject. 

Broadening  the  Therapeutic  Horizon.  Now  that  the  in- 
terest of  the  aggressive  section  of  the  profession  is  being 
focused  upon  these  glands,  and  much  regarding  their  study 
and  the  importance  of  the  many  phases  of  the  subject  is 
appearing  in  current  medical  literature,  a  comparatively  new 
branch  of  medicine  is  gradually  being  differentiated,  and 
with  our  better  knowledge  of  the  physiology  of  the  hormone- 
producing  organs,  there  comes  not  merely  an  increased 
diagnostic  skill,  but  a  broadened  therapeutic  horizon,  for 
in  the  study  of  the  internal  secretions  lies  the  future  of  the 
treatment  of  most  functional  disorders.  To  tell  the  truth 
the  extensive  ramifications  of  this  subject  and  the  increas- 
ing prominence  of  the  endocrine  features  in  so  many  minor 
as  well  as  important  disorders,  are  awakening  an  interest 
in  the  new  specialty.  As  Sajous  says,  this  branch  of  medicine 
"claims  the  right  to  exist  as  a  specialty,  for  its  field  is 
greater  in  scope  than  some  which  have  earned  well  merited 
recognition."  (Hemadenology:  A  New  Specialty,  N.  Y. 
Med.  Jour.,  Feb.  20,  1915,  p.  365.)  Sajous  then  continues: 
"Its  influence  on  the  improvement  of  the  race  through  the 
light  it  will  shed  upon  the  pathology  of  the  unfit,  mental  and 
physical,  cannot  but  prove  a  blessing.  If  to  this  we  add  the 
many  disorders  it  will  serve  to  elucidate  through  collective 
effort  on  the  part  of  the  host  of  investigators  it  is  bound 
to  enlist  .  .  .  the  day  may  come  when  the  inaugura- 
tion of  hemadenology  may  be  considered  as  having  marked 
a  new  epoch  in  medicine." 

All  who  have  studied  this  subject  admit  that  it  has  a 
fascination  that  cannot  be  measured.  The  profitable  appli- 
cations that  have  been  made  in  clinical  practice  by  the  em- 
ployment of  organotherapy,  or  "hormone  therapy,"  explain 
in  a  good  measure  the  favor  with  which  this  subject  is  being 
received  by  the  medical  world. 

As  we  occupy  ourselves  in  searching  for  the  earliest  signs 
of  endocrine  disorder,  automatically  we  gain  a  better  insight 
into  the  intricacies  of  the  functions  of  the  body  and  are  not 
merely  able  to  forestall  the  later  and  more  serious  organic 
disease,  but  so  often  we  run  across  associated  manifesta- 
tions of  the  most  diversified  kinds,  from  nocturnal  enuresis 
to  chilblains  or  from  neurasthenia  to  a  stiff  neck,  which 


FREQUENCY  OF  ENDOCRINE  DISORDERS  83 

may  be  modified  directly  by  suitable  organotherapeutic 
measures  which  we  may  be  directing  toward  an  associated 
but  entirely  different  condition. 

What  Some  Authorities  Have  Said.  None  can  deny  that 
a  knowledge  of  these  associated  subjects — endocrinology  and 
organotherapy — has  put  an  entirely  new  aspect  on  the  out- 
come of  many  intractable  disorders.  The  increasing  appre- 
ciation of  the  role  of  the  endocrine  glands  has,  as  Leonard 
Williams  has  said,  "lightened  our  darkness  and  shown  us 
miracles."  What  other  word  than  "miracle"  can  be  applied 
to  the  startling  effects  of  thyroid  feeding  upon  the  pitiful 
conditions  of  cretinism.  How  many  of  the  "darknesses"  of 
practical  medicine  are  being  illuminated  by  what  science 
has  taught  us  regarding  the  hormones  in  physiology  and 
therapeutics,  will  be  more  evident  as  the  reader  finds  op- 
portunity to  apply  this  knowledge  in  his  daily  routine. 

In  the  words  of  an  editorial  writer  in  American  Medicine-' 
"Many  a  chronic  and  intractable  disorder  is  due  to  an  over- 
looked defect  in  the  production  of  the  hormones  of  the  in- 
ternal secretory  glands.  Increasingly  greater  stress  is  being 
laid  upon  the  importance  of  these  chemical  messengers,  and 
there  is  now  little  doubt  that  in  health  as  well  as  in  disease 
they  regulate  and  correlate  the  metabolic  activities  of  the 
body."  Again  the  importance  of  this  is  emphasized  in  a 
recent  review  in  the  Lancet  from  which  we  quote:  "As 
our  knowledge  has  progressed,  the  influence  of  the  ductless 
glandular  system  has  proved  to  be  far  wider  and  more  pene- 
trating than  any  of  the  earlier  investigators  suspected.  It 
controls  growth  and  metabolism  and  in  short  determines 
largely  the  nature  of  that  factor  which  the  older  physicians 
spoke  of  as  'constitution.'  " 

The  internal  secretions  have  revolutionized  physiology 
and  with  it  clinical  medicine,  just  as  organotherapy  has 
revolutionized  certain  phases  of  treatment;  hence  the  gen- 
eral practitioner,  above  all  others,  stands  to  benefit  by  this 
added  fund  of  knowledge.  As  we  become  better  acquainted 
with  the  endocrine  disorders  it  will  be  noticed  that  intima- 
tions of  their  presence  are  staring  at  us  in  every  turn  in 
our  daily  routine;  and  we  shall  find  many  an  occasion  to 
congratulate  ourselves  that  we  have  taken  time  to  investi- 
gate this  fascinating  and  interesting  subject. 

With  the  vital  importance  of  the  endocrine  glands  firmly 
in  our  minds,  we  may  properly  consider  some  of  the  infor- 
mation to  be  found  in  current  books  and  medical  literature 
regarding  diagnostics  of  everyday  clinical  endocrinology^ 


84  PRACTICAL  ORGANOTHERAPY 

SECTION  IV.    CHAPTER  2 
THE  MINOR  THYROID  DISORDERS 


A  full  appreciation  of  the  clinical  importance  of  the  dis- 
orders of  the  thyroid  gland  presupposes  a  knowledge  of  the 
essential  role  that  it  plays  in  the  regulation  of  the  functions 
of  the  body.  Truly  it  is  a  nmst  wonderful  organ,  and  it 
has  been  called  very  aptly  "the  keystone  of  the  endocrine 
arch,"  because  it  is  concerned  directly  or  indirectly  in  the 
work  of  practically  every  one  of  the  series  of  ductless 
glands. 

The  Director  of  Metabolism.  As  such  it  is  the  most  im- 
portant single  factor  in  the  direction  of  the  intricate  work- 
ings of  metabolism,  for  it  has  been  well  affirmed  that  the 
thyroid  governs  growth  and  development — physical  and 
mental — controls  the  breaking  down  of  certain  food  mate- 
rials, particularly  albumin,  and  has  much  to  do  with  the 
regulation  of  the  complex  chemical  processes  by  means  of 
which  the  cellular  wastes  are  disposed  of.  As  a  consequence 
of  this  many  different  physiological  manifestations  are 
intimately  bound  up  with  the  work  of  the  thyroid,  and  its 
functional  disorders,  no  matter  how  slight,  are  imme- 
diately reflected  in  such  functions  as  heat  regulation,  mus- 
cular efficiency,  peristalsis,  urinary  excretion  especially  the 
elimination  of  nitrogen,  menstruation  and  other  activities 
of  the  gonads  (essential  sex  glands),  both  in  the  male  and 
the  female,  the  different  features  of  mental  capacity, 
hematopoiesis,  nutrition  especially  of  the  skin  and  its  ap- 
pendages, as  well  as  the  development  of  features,  form  and 
function  generally. 

The  thyroid  hormone  also  has  to  do  with  the  powers  of 
the  body  to  resist  disease.  Sajous  was  among  the  earliest 
to  connect  its  work  with  the  production  of  immunity,  and  it 
has  been  shown  to  be  the  most  important  of  the  numerous 
detoxicating  agencies  at  work  in  the  body.  This  last  makes 
the  thyroid  especially  susceptible  to  the  toxemias  associated 
with  the  infectious  diseases  and  the  infections,  in  fact  the 
chief  causes  of  thyroid  insufficiency — the  minor  and  by  far 
the  most  frequent  form  especially — are  the  infectious  dis- 
eases, principally  tuberculosis,  syphilis  and  the  exanthemata 
and,  of  course,  typhoid,  diphtheria,  rheumatic  fever,  influ- 
enza, erysipelas  and  many  other  acute  and  chronic  focal 
infections. 


MINOR  THYROID  DISORDERS  85 

The  Relation  to  the  Sex  Glands.  The  predominating  in- 
fluence of  the  thyroid  upon  the  functions  of  the  gonads  ren- 
ders it  peculiarly  sensitive  to  variations  in  the  sexual  life, 
especially  in  women;  and  emotional  and  sexual  excess,  as 
well  as  the  toxic  and  functional  disorders  associated  with 
pregnancy,  are  frequent  causes  of  the  slighter  forms  of 
thyroid  insufficiency.  On  the  other  hand  the  sex  hormones 
react  upon  the  thyroid,  and  thyroid  dysfunction  is  a  com- 
mon result  of  disturbed  gonad  function,  especially  of  the 
ovaries.  Incidentally  this  lends  emphasis  to  one  of  the 
difficulties  of  endocrine  diagnosis — both  thyroid  and  ovaries 
react  upon  each  other  and  it  is  sometimes  difficult  to  know 
whether  a  given  condition  is  causative  or  resultant. 

The  intimate  relation  of  the  thyroid  to  metabolism,  par- 
ticularly that  of  proteids,  makes  it  react  to  that  unfortu- 
nately all-too-common  etiologic  factor  in  so  many  disorders 
— overfeeding,  and  this  is  particularly  true  of  a  diet  in 
which  meat  forms  a  generous  part.  Intoxications  of  all 
kinds — intestinal,  alcoholic,  drug  and  those  due  to  ameba 
in  the  mouth  or  tonsils  and  to  intestinal  and  other  parasites 
— are  not  infrequent  exciting  causes  of  a  breakdown  in  the 
thyroid  function. 

With  the  foregoing  suggestions  in  mind,  coupled  with  the 
fundamental  physiological  fact  that  the  thyroid  is  as  im- 
portant a  factor  as  any  in  the  detoxicating  and  immunizing 
processes  of  the  body,  it  will  be  clear  that  the  detection  of 
a  minor  functional  disorder  of  this  gland  may  be  of  much 
more  service  than  merely  to  direct  attention  to  the  meas- 
ures necessary  to  reinforce  the  work  of  the  lagging  gland. 
A  much  more  important  thing  will  have  been  accomplished 
if,  in  addition  to  this,  the  underlying  causative  element  is 
laid  bare  and  steps  taken  to  eradicate  it  or  to  nullify  its 
influence.  Very,  very  often  the  proper  adjuvant  treatment 
of  thyroid  inadequacy — the  treatment  of  its  cause  as  well 
as  its  results — is  made  possible  by  applying  our  increased 
knowledge  in  the  right  way.  Hence  we  would  naturally 
supplement  thyroid  medication  with  emetine  where  alveolar 
or  tonsillar  amebiasis  is  present  whether  the  infection  has 
made  itself  prominent  or  not.  Bacterial  vaccines  would  be 
administered  where  there  is  a  definite  underlying  bacterial 
origin,  autogenous  vaccines  where  cultures  may  be  made 
easily,  or,  better  still,  mixed  stock  vaccines,  especially  where 
it  is  difficult  to  locate  the  nidus  of  infection  and  secure  a 
culture.  Again  systemic  alkalinization  or  remineralization, 
as  the  French  usually  call  it,  (see  Sec.  V,  Chap  25)  is  very 


86  PRACTICAL  ORGANOTHERAPY 

much  in  order  where  acidosis  and  toxemia  are  prominent; 
in  fact  in  almost  every  case  of  chronic  benign  thyroid  insuf- 
ficiency, generous  and  judiciously  timed  doses  of  the  alka- 
lies, preferably  in  proportions  similar  to  those  found  in  the 
blood,  will  make  the  response  to  thyroid  therapy  much  more 
satisfactory.  Where  intestinal  concretions  are  palpable  and 
stasis  is  obvious,  eliminating  and  lubricating  remedies  facili- 
tate the  best  results  by  removing  the  wastes  which  do  not 
merely  aggravate  the  manifestations  of  thyroid  disorder, 
but  hinder  every  function  of  the  body. 

For  these  reasons,  then,  I  rarely  employ  thyroid  medica- 
tion without  some  associated  treatment,  and  am  confident 
that  many  a  failure  in  this  line  of  therapeutic  effort  is  due 
to  the  omission  of  the  necessary  adjunct  measures;  for 
many  a  time  it  will  be  found  that  a  certain  method  of  treat- 
ment is  rendered  much  more  efficient  by  the  addition  of 
thyroid  (say  ^4  or  l/2  a  grain  three  times  a  day),  while 
the  reverse  is  equally  true — thyroid  therapy  is  enhanced 
by  combining  with  it  other  suitable  treatment  the  need  for 
which  is  too  often  overlooked. 

Before  we  pass  from  the  consideration  of  the  underlying 
basis  of  thyroid  disorder  a  word  of  emphasis  may  be  ad- 
vantageously placed  right  here.  Has  it  ever  occurred  to  the 
reader  that  one  of  the  commonest  features  of  the  heavy 
eater  or  drinker  is  obesity,  and  that  this  is  also  a  common 
and  quite  constant  feature  of  hypo-thyroidism  ?  Why  should 
the  thyroid  glands  of  those  who  are  wont  to  abuse  their 
bodies  be  so  immune  to  the  influence  of  the  very  factors 
which  most  commonly  disturb  their  function  ?  They  are  not, 
and  an  almost  constant  feature  of  such  individuals  is 
hypothyroidism  manifested  in  not  a  few  disorders  other 
than  the  one  just  mentioned,  of  which  we  shall  shortly  learn. 
It  is  fair  to  add  that  these  factors  just  mentioned  are  not 
the  only  causes  of  the  thyroid  type  of  obesity,  for  in  some 
cases  the  cause  cannot  be  established. 

The  Predisposing  Causes  of  Thyroid  Instability.  All  these 
exciting  factors,  and  others  quite  similar  to  them,  are  clearly 
much  more  effectual  disturbers  of  the  chemical  routine  of 
the  thyroid  gland  when  the  individual  has  an  unstable  thy- 
roid mechanism  to  start  with ;  and  as  with  the  major  thyroid 
diseases,  about  which  we  shall  have  more  to  say  later, 
heredity  is  the  one  great  foundation  upon  which  a  suscepti- 
bility to  thyroid  dyscrasia  is  built.  This  is  the  great  pre- 
disposing cause  while  the  toxemias  and  other  circumstances 
previously  mentioned  are  the  principal  exciting  causes. 


MINOR  THYROID  DISORDERS  8T 

Many  conditions  combine  to  favor  the  production  of  con- 
genitally  subthyroidic  children,  most  important  among 
which  are  various  degrees  of  the  same  disorder  in  the  par- 
ents and  especially  the  mother.  Transmitted  tendencies 
toward  tuberculosis,  malnutrition  and  other  congenital 
ills  to  which  the  flesh  is  all  too  often  heir,  are  almost 
invariably  associated  with  thyroid  instability.  Nor  must 
we  forget  among  causes  of  these  tendencies,  inherited 
syphilis — a  most  potent  cause  of  every  kind  of  functional 
and  organic  disease  of  the  glands  of  internal  secretion. 
By  thyroid  instability  is  meant,  not  necessarily  definite 
thyroid  disease  of  varying  degree,  but  an  inherent  cellular 
weakness  of  the  gland  which  permits  it  to  succumb  to  the 
first  serious  stress  that  may  be  put  upon  it. 

Usually  this  extra  strain  may  be  the  result  of  some  of  the 
common  infectious  diseases  of  childhood  (incidentally  chil- 
dren with  this  unstable  condition  are  just  the  ones  who 
"catch  everything")  or  it  may  not  appear  until  puberty,  at 
which  period  many  a  thyroid  insufficiency  of  more  or  less 
permanency  first  makes  itself  manifest  either  by  structural 
changes,  as  in  goitre,  or  by  the  disturbances  which  result 
from  hypothyroidism. 

Early  Causes  of  Thyroid  Disorder.  Other  factors  which 
favor  the  hereditary  subthyroidism  in  children  are  toxemias 
during  pregnancy  and  labor  prior  to  their  birth.  I  have 
frequently  found  a  connecting  thread  between  such  con- 
ditions and  the  complex  endocrine  disorders  which  I  so 
often  see,  and  it  would  be  interesting  to  see  a  report  of  the 
thyroid  findings  in  a  goodly  number  of  individuals  whose 
advent  into  the  world  was  the  occasion  of  eclampsia,  some 
figures  which  I  do  not  believe  have  yet  crept  into  medical 
literature.  Important  among  the  other  predisposing  heredi- 
tary causes  of  thyroid  instability  are  unduly  frequent  child- 
bearing,  prolonged  lactation  and  like  physical  strains  upon 
the  system  of  the  mother  during  pregnancy.  Acute  infec- 
tious diseases  of  the  mother  may  cause  this  tendency  in  her 
offspring ;  though  it  should  be  said  with  emphasis  that  these 
conditions  just  mentioned  do  not  necessarily  spell  thyroid 
inadequacy  in  the  child  and,  of  course,  a  constitution  may  be 
acquired  after  birth  in  spite  of  a  poor  heredity. 

Perhaps  additional  emphasis  should  be  given  to  the  im- 
portance of  syphilis  as  a  predisposing  as  well  as  an  exciting 
factor  in  this  class  of  cases.  We  are  taught  to  consider 
syphilis  as  a  prospective  cause  of  every  obscure  and  difficult 
condition  and  to  presume  its  presence  until  it  is  definitely 


88  PRACTICAL  ORGANOTHERAPY 

ruled  out.  This  is  the  correct  though  not  the  usual  way  to 
look  at  the  subject.  The  advent  of  the  Wassermann  test 
and  its  standardization  and  control  by  other  procedures  has 
made  it  possible  to  know  with  definiteness  whether  the 
syphilitic  factor  is  present  or  not,  and  every  insidious  case 
of  this  character  should  have  the  benefit  of  the  Wasser- 
man  test,  at  least  of  the  blood,  and  not  infrequently  of  the 
spinal  fluid  also. 

Syphilis  is  the  most  insidious  of  all  diseases  and  is  most 
protean  in  its  manifestations,  and  Dr.  L.  F.  Barker,  of  Johns 
Hopkins,  was  right  when  he  once  told  the  New  York  Acad- 
emy of  Medicine  that  "the  more  my  experience  grows,  the 
more  I  am  inclined  to  take  as  a  diagnostic  aphorism,  'When 
in  doubt  have  a  Wassermann  test  made ;  when  not  in  doubt 
still  have  a  Wassermann  test  made.' '  And  in  no  class 
of  disorders,  is  this  more  truly  applicable  than  in  the  obscure 
and  insidious,  as  in  the  obvious  and  organic,  diseases  of  the 
glands  of  internal  secretion. 

Having  attempted  to  direct  attention  to  the  numerous 
contributory  causes  of  thyroid  dyscrasias,  as  well  as  to  the 
factors  which  are  likely  to  precipitate  slight  or  well  marked 
thyroid  insufficiency,  we  can  now  more  intelligently  proceed 
to  consider  the  clinical  results  of  this  condition,  and  to  a 
study  of  how  to  detect  the  usual  and  unusual  symptoms  of 
this  common  disorder. 

From  what  has  been  said  regarding  the  exciting  and  pre- 
disposing causes  of  thyroid  disorder,  it  will  be  clear  that 
the  history,  both  personal  and  family,  is  particularly  impor- 
tant as  in  it  we  may  find  a  strong  hint  as  to  the  prospective 
presence  of  the  condition  for  which  we  are-  looking,  although 
we  may  not  always  find  a  basic  reason  of  this  character  in 
our  anamnesis,  for  thyroid  disturbances  have  a  habit  of 
appearing  without  the  necessary  hereditary  or  even  the  pre- 
sumably essential  etiologic  foundation. 

Hypothyroidism  may  be  found  at  any  time  during  life, 
from  infancy  to  old  age,  though  it  is  most  common  in  young 
persons.  The  more  serious  forms  are  likely  to  show  them- 
selves in  infancy  or  youth,  while  the  forms  that  are  usually 
overlooked  altogether  are  more  usual  during  the  thirty  or 
more  years  of  active  reproductive  life  and,  as  has  been 
mentioned,  it  is  especially  frequent  in  women. 

The  Frequency  of  Hypothyroidism.  Thyroid  insufficien- 
cies are  more  frequent  than  the  exanthemata.  Minor  hypo- 
thyroidism  is  among  the  commonest  of  disorders.  It  com- 
plicates pediatric  problems  more  often  than  almost  any 


MINOR  THYROID  DISORDERS  89 

other  single  condition  except,  of  course,  disorders  of  infec- 
tive origin.  It  is  equally  important  in  the  etiology  of  many 
functional  gynecological  troubles  as  well  as  in  many  of  the 
complexities  of  internal  medicine.  Neurologists  are  now 
coming  to  consider  it  as  a  much  more  vital  factor  in  their 
difficult  cases  than  has  previously  been  supposed  and  it  may 
be  considered  to  be  an  insidious  complicating  element  in 
many  chronic  diseases  including  that  symptom-complex 
usually  called  "neurasthenia"  for  the  lack  of  a  better  name. 

Close  study  is  always  rewarded  by  results  which  usually 
have  a  very  definite  clinical  significance.  This  is  as  true 
in  endocrinology  as  elsewhere;  and  to  the  seeing  eye  is 
unfolded  many  an  obscure  condition  of  daily  occurrence. 
These  are  obscure  merely  because  their  insidious  onset  hides 
them.  They  have  not  been  looked  for.  The  secret  of  suc- 
cess in  endocrinology  is  thoroughness.  It  is  the  little  things 
that  count ;  and  it  is  surprising  how  the  appreciation  of  a 
seemingly  insignificant  circumstance  enables  us  to  correlate 
some  other  equally  insignificant  condition,  and  thus  to  pass 
the  unseen  barrier  which  has  been  separating  us  from  a 
full  understanding  of  a  given  case. 

The  processes  of  cell-exchange,  nutritional  and  elimina- 
tive,  influence  all  parts  of  the  body,  hence,  as  Hertoghe  puts 
it:  "No  tissue  is  able  to  escape  the  results  of  impoverish- 
ment of  the  thyroid  gland."  These  results  are  just  as  real 
and  important  from  a  practical  standpoint  as  many  other 
obscure  but  none  the  less  important  disorders.  They  are 
often  even  more  important,  for  their  very  obscurity  means 
that  their  discovery  may  be  of  unusual  helpfulness.  The 
fact  that  they  have  been  overlooked  has  made  a  great  dif- 
ference to  the  treatment  and  accounts  for  many  failures; 
and  their  discovery  may  put  an  entirely  new  aspect  upon 
the  prognosis,  for  the  treatment  of  internal  secretory  dis- 
orders with  well  marked  and  organic  involvement  is  not 
always  as  successful  as  that  of  those  conditions  in  which 
only  the  early,  functional  changes  are  beginning. 

Infiltration,  the  Chief  Symptom  of  Hypothyroidism.  When 
we  recall  the  principal  intracellular  functions  of  the  thy- 
roid hormone,  it  will  be  easy  to  understand  that  aberra- 
tions in  the  production  of  this  chemical  messenger  not  only 
interfere  with  cellular  growth,  but  they  derange  the  essen- 
tial chemical  changes  connected  with  the  incessant  regen- 
eration of  the  cells  themselves.  Their  waste  products  are 
retained  and  the  effete  material  is  not  burned  up — facts 
which  are  proved  in  several  different  ways.  The  chief 


90  PRACTICAL  ORGANOTHERAPY 

result  of  this  special  form  of  suboxidation  is  the  establish- 
ment of  a  condition  of  cellular  infiltration  which  varies  both 
in  degree  and  in  the  number  and  location  of  the  organs 
attacked.  That  it  is  often  generalized  cannot  be  denied,  but 
that  it  is  more  manifest  in  some  tissues  is  also  true,  as  we 
shall  see  when  the  results  of  the  more  serious  forms  of 
thyroid  disease  are  considered. 

While  the  loss  of  the  normal  thyroid  stimuli  may  account 
for  many  disorders,  more  clinical  symptoms  result  from  this 
infiltration  than  from  any  other  single  result  of  thyroid 
derangement.  As  we  enumerate  the  symptoms  of  thyroid 
disorder  this  one  factor — infiltration — stands  out  above  all 
the  others,  and  when  its  importance  and  extent,  as  well  as 
the  fundamental  philosophy  of  its  presence,  is  thoroughly 
understood,  it  will  explain  many  a  symptom  which  pre- 
viously had  not  been  supposed  to  have  the  least  to  do  with 
this  gland.  The  credit  for  the  discovery  and  announcement 
of  this  phenomenon  undoubtedly  belongs  to  my  good  friend 
Dr.  Eugene  Hertoghe,  of  Antwerp;  and  to  him  is  due  the 
homage  of  the  medical  profession  for  his  remarkable  con- 
tributions on  this  subject.  The  importance  of  the  whole 
subject  may  be  impressed  by  a  quotation  from  one  of  his 
more  recent  papers  ("Thyroid  Insufficiency/'  Practitioner, 
Jan.,  1915,  p.  27).  "It  is  obvious  that  myxedematous  dwarf- 
ism  and  infantile  cretinism  cannot  escape  detection  by  a 
physician  of  even  moderate  attainments  .  .  .  but  the 
slighter  forms  of  thyroid  inadequacy  are  almost  invariably 
missed ;  yet,  owing  to  their  extreme  prevalence,  the  recogni- 
tion of  these  is  extremely  important" — although  more  than 
twenty  years  have  passed  since  the  symptomatology  of 
"chronic  benign  thyroid  insufficiency"  or  "myxedeme 
fruste"  was  first  described. 

This  is  just  as  true  of  the  other  functional  endocrine  dis- 
orders, and  the  fact  that  they  are  so  very  often  overlooked, 
and  information  as  to  how  to  detect  them  is  not  easy  to 
obtain,  is,  it  is  to  be  hoped,  a  sufficiently  good  reason  for 
the  emphasis  which  is  being  laid  on  the  subject  here. 

Numerous  Clinical  Findings.  So  many  organs  and  sys- 
tems may  be  affected  by  disturbed  thyroid  secretion  that  it 
is  necessary  to  consider  separately  the  principal  changes 
in  the  different  tissues.  It  should  be  remarked,  however, 
that  not  all  of  the  conditions  shortly  to  be  enumerated  will 
be  found  together  in  a  given  case,  not  even  in  the  serious 
form  of  hypothyroidism.  The  detection  of  several  of  them 
is  sufficient  ground  for  the  application  of  suitable  thyroid 


MINOR  THYROID  DISORDERS  91 

therapy.  This  is  not  empirical  thyroid  medication,  for 
further  proof  of  its  scientific  basis  is  forthcoming-  when  the 
response  is  favorable,  and  Hertoghe's  statement  must  be 
taken  as  axiomatic  that  "those  who  derive  benefit  from 
thyroid  medication  invariably  will  be  found  to  show  symp- 
toms of  thyroid  inadequacy ;"  and  if  thyroid  may  have  been 
indiscriminately  administered — a  not  infrequent  happening 
— and  the  results  are  favorable,  this  may  be  taken  as  a 
therapeutic-diagnostic  test.* 

Inadequate  or  suppressed  thyroid  function  causes  morbid 
syndromes  in  direct  ratio  to  the  loss  of  the  thyroid  hormone 
to  the  body;  and  this  may  affect  almost  every  tissue  and 
function.  Perhaps  the  most  common  and  constant  changes 
resulting  from  hypothyroidism  are  seen  in  the  skin  and  its 
appendages.  It  is  infiltrated  with  waste  products,  puffy  and 
insufficiently  nourished  so  that  it  becomes  dry,  rough  and 
desquamating.  Sensible  perspiration  is  reduced  and  in  ad- 
vanced cases  not  even  exertion  in  summer  heat  will  awaken 
the  dormant  sweat  glands.  Usually  the  more  marked 
edema  is  only  present  in  myxedema  which  will  be  considered 
later.  Many  dermatoses  may  be  found.  In  children  eczema 
is  most  common;  at  puberty,  especially  in  girls,  acne  and 
in  adults  herpes,  psoriasis,  urticaria  and  dermal  malnutri- 
tion and  susceptibility  to  slight  cutaneous  infections  with 
varying  symptoms.  According  to  Leopold  Levi,  subthyroid- 
ism  provides  a  favorable  soil  for  recurrent  erysipelas  and 
he  has  found  that  this  condition  has  yielded  readily  to 
thyroid. 

As  a  result  of  the  infiltration  the  hair  is  sparse,  thin  and 
ill  nourished,  falls  out  easily  and  characteristic  of  certain 
stages  of  this  condition  is  the  "signe  du  sourcil" — a  com- 
mencing of  absolute  loss  of  the  outer  third  of  the  eyebrows. 
For  the  same  fundamental  reason  the  nails  are  often  striated 
and  brittle,  later  cracking  very  easily.  The  teeth  are  bad, 
caries  being  a  common  result  of  hypothyroidism,  and  a 
routine  finding  in  children  with  thyroid  defects.  In  fact 
the  child  with  bad  teeth  should  be  studied  from  this  par- 
ticular viewpoint,  and  very  frequently  other  prominent 
results  of  the  underlying  hypothyroidism  are  discovered; 
and  the  obvious  treatment  will  be  most  helpful  besides  local 
dental  care. 

Deficient  Oxidation,  the  Rule.  The  metabolism  as  esti- 
mated by  the  calorimetric  Basal  Metabolism  Test  is  de- 


*  Elsewhere  a  method  of  testing  thyroid  function  is  outlined.  ^  It  is 
really  a  routine,  uniform  application  of  the  principle  just  mentioned. 


92  PRACTICAL  ORGANOTHERAPY 

creased  in  proportion  to  the  thyroid  deficiency.  The  "B. 
M.  R."  often  is  15,  20  or  even  30%  below  the  normal.  The 
generally  deficient  cell  oxidation  commonly  results  in  the 
temperature  being  below  normal,  and  occasionally  it  is  lower 
in  the  late  afternoon  at  which  time  there  may  be  fits  of 
shivering,  at  times  simulating  malaria  very  much.  There  is 
a  general  chilliness  and  the  extremities  are  cold.  These 
individuals  feel  the  cold  very  much  and  require  undue 
amounts  of  clothing  or  bed  coverings.  They  are  continually 
complaining  about  the  cold,  take  all  sorts  of  precautions  to 
guard  against  it  and  slight  draughts  cause  rheumatoid  or 
neuralgic  pains.  "Dead  fingers"  are  often  due  to  this  cause 
and  cyanosis  and  even  chilblains  are  connected  by  many 
authorities  with  hypothyroidism.  Raynaud's  symmetrical 
gangrene  and  other  forms  of  vasomotor  spasm  with  skin 
manifestations  are  also  credited  to  the  same  fundamental 
cause;  and  time  and  again  have  disappeared  when  suitable 
needed  treatment  is  instituted. 

Fatigue,  especially  in  the  morning,  is  usual.  Subjects  of 
this  disorder  were  "born  tired"  and  require  much  sleep. 
The  cellular  apathy  causes  them  to  sleep  very  heavily,  often 
in  the  day,  especially  after  eating.  There  is  a  feeling  of 
depression  and  well-marked  cases  are  apathetic,  disinter- 
ested and  "lazy." 

The  infiltration  and  generally  devitalized  condition  natu- 
rally favors  obesity.  The  muscles,  joints  and  ligaments  are 
all  similarly  influenced,  producing  such  common  symptoms 
as  "rheumatism,"  stiff  neck,  aching  in  the  limbs  and  back 
often  especially  marked  between  the  scapulae.  The  joints 
may  be  stiff  and  occasional  swelling  may  suggest  arthritis 
and  even  ankylosis.  Cracking  noises  in  the  joints  are  not 
unusual  and  Hertoghe  speaks  of  it  being  very  common  in 
the  knees.  The  involuntary  muscles  are  also  affected,  the 
intestinal  and  abdominal  walls  are  weak  and  ptosis  is  the 
rule.  Stasis,  constipation  and  the  accompanying  toxemia 
complete  a  vicious  circle. 

Constipation  and  Stasis.  Many  of  the  symptoms  so 
widely  emphasized  by  Sir  Arbuthnot  Lane  were  connected 
and  described  by  Hertoghe  15  years  before  and  definitely 
credited  to  "benign  chronic  subthyroidism."  (See  E.  Her- 
toghe, Bull.  Acad.  Med.  de  Belg.  March,  1899,  p.  231.) 
For  many  years  he  has  successfully  treated  such  cases  on 
this  basis,  and  while  there  may  be  an  advantage  in  the 
present  vogue  of  intestinal  lubrication  and,  rarely,  even  in 
the  operative  measures  recommended,  the  elucidation  of  the 


MINOR  THYROID  DISORDERS  93 

fundamental  cause  and  its  removal  is  a  much  more  satisfy- 
ing, as  well  as  rational,  procedure.  Obstipation  of  the  most 
aggravating  type  is  not  uncommon.  The  stools  are  hard 
because  of  the  decreased  alimentary  secretion.  The  appe- 
tite may  be  progressively  poor  and  certain  foods,  especially 
meat,  are  intensely  disliked.  The  appearance  is  toxic  and 
often  prematurely  senile  and  in  advanced  cases  a  brownish 
pigmentation  of  the  skin  has  been  remarked  by  some 
writers. 

A  sensation  of  heaviness  over  the  epigastrium  is  not  un- 
usual and  biliary  colic  has  been  caused  by  thyroid  infiltra- 
tion and  nothing  else;  and  nutrition  is  below  par,  though 
the  weight  may  be  normal  or,  more  often,  increased.  There 
is  a  reduction  in  weight  when  our  therapeutic  efforts  begin 
to  relieve  the  infiltrated  cells  throughout  the  body  of  their 
accumulated  wastes.  Hertoghe  uses  the  term  "thyroid 
inanition"  which  refers  to  a  condition  of  cell  starvation, 
inactivity  and  asthenia  without  obvious  changes  in  contour 
or  weight.  Vomiting,  in  some  cases,  may  be  due  to  this 
same  fundamental  cause,  especially  when  associated  with 
pregnancy. 

Cardio- Circulatory  Asthenia.  The  infiltration  does  not 
miss  the  cardiac  muscle  and  in  consequence  "".lie  heart 
action  is  weak  and  the  pulse  usually  slower  '.lan  normal. 
Circulation  is  especially  poor,  accounting  for  some  of  the 
manifestations  (associated  with  the  infiltration)  just  con- 
nected with  hypothermia.  Respiratory  oppression  and 
varying  degrees  of  dyspnea  are  frequent.  Occasionally  this 
is  intermittent  and  mistaken  for  asthma,  thus  explaining 
the  occasional  unexpected  cures  in  "asthma"  following 
thyroid  therapy.  According  to  Hertoghe  "the  physiologic 
stimulant  of  the  heart  is  supplied  by  the  thyroid.  It  is,  in 
a  certain  sense,  the  necessary  tonic,  the  normal  digitalis,  by 
which  cardiac  activity  is  promoted  and  maintained.  .  .  . 
I  do  not  hesitate  to  exhibit  thyroid  extract  in  cases  of  weak 
contractility  and  tendency  to  syncope,  and  I  may  say  that 
the  treatment  has  never  failed  me."  (See  article  mentioned 
above.) 

Bladder  Symptoms.  The  desquamation  so  marked  on  the 
epidermis,  as  well  as  the  infiltration  and  loss  of  function  due 
to,  it,  are  also  present  in  the  bladder  which,  by  the  way, 
seems  to  be  peculiarly  supersensitive  in  hypothyroidism.  An 
excess  of  squamous  cells  is  common  among  the  urinary  find- 
ings, and  the  incessant  denudation  results  in  an  undue  sensi- 
tiveness to  contact  with  the  urine,  causing  frequent  urina- 


94  PRACTICAL  ORGANOTHERAPY 

tion  and  enuresis,  especially  in  children  who,  it  will  be 
remembered,  are  very  heavy  sleepers  (with  consequent 
decreased  control  over  the  ejaculator  urinae  reflex)  as  a 
result  of  which  bed  wetting  is  not  unusual.  The  other 
urinary  findings  show  the  reduced  oxidation  very  plainly. 
This  is  especially  noticeable  in  the  low  urea  output.  In 
such  cases  there  is  often  a  tendency  to  acidosis  and  an  esti- 
mation of  the  ammonia  will  show  that  generally  it  is  unduly 
increased,  due  to  the  imperfect  metabolism  in  the  liver  of 
the  "urea  precursors."  It  almost  seems  that  there  is  a  dis- 
tinct connection  between  the  thyroid  and  the  liver,  for  in 
the  more  marked  cases  of  hypothyroidism,  not  only  are  the 
chemical  functions  of  the  liver  disturbed,  but  it  becomes 
infiltrated,  passively  congested  and  tender  on  pressure.  The 
same  is  true  of  the  gall  bladder  and  the  desquamation  there 
favors  the  production  of  gall  stones  or  jaundice  with  their 
usual  symptoms. 

Mental  Slowness.  The  mental  disturbances  are  many  and 
varied.  Slowness  characterizes  every  form  of  mental  action. 
The  memory  becomes  gradually  poor,  there  is  difficulty  in 
following  a  line  of  thought  or  reasoning.  Apathy,  som- 
nolence and  melancholia  and  in  the  more  marked  cases  or- 
ganic brain  disorders  with  varying  forms  of  mental  defi- 
ciency may  be  present.  Headache  is  a  usual  and  early  symp- 
tom, especially  when  it  occurs  early  in  the  day.  It  is  so 
constant  in  some  cases  that  they  have  accustomed  them- 
selves to  it,  and  "have  it  all  the  time."  Neuralgia  and 
migraine  have  been  definitely  traced  to  the  thyroid  and  the 
conclusions  verified  by  the  therapeutic  test.  Two  insidious 
subjective  symptoms  may  be  present  which  are  rarely 
thought  of  in  connection  with  this  disorder.  These  are  gid- 
diness and  noises  in  the  ear.  The  generalized  infiltration  is 
again  responsible,  and  the  same  thing  also  may  cause 
hoarseness,  a  change  in  the  timbre  of  the  voice,  and  even 
aphonia. 

Influence  on  the  Ovaries.  The  effects  of  thyroid  dyscrasia 
on  the  gonads  are  well  marked  and  among  the  most  con- 
stant findings,  especially  in  women.  Early  thyroid  disorder 
spells  late  reproductive  activity.  Often  the  menses  are  de- 
layed for  years,  or  after  having  started  may  be  suppressed 
for  a  varying  period.  Amenorrhea  is  sometimes  noticed, 
especially  in  young  girls ;  but  in  women,  especially  towards 
the  close  of  reproductive  activity,  when  the  characteristic 
infiltration  is  present,  the  reverse  is  the  rule.  Menorrhagia, 
severe  and  persistent,  is  a  common  result.  It  is  believed  by 


MINOR  THYROID  DISORDERS  95 

some  that  the  thyroid  has  something  to  do  with  the  develop- 
ment of  the  uterus,  and  that  when  hypothyroidism  is  fairly 
well  marked  the  posterior  uterine  wall  is  not  properly  devel- 
oped, sometimes  causing  a  marked  retroflexion  which  may 
be  a  part  of  the  cause  of  the  menorrhagia.  The  menses  are 
prolonged,  may  recommence  after  they  are  apparently  over, 
the  frequency  of  the  periods  is  increased  and  the  loss  of 
strength  and  activity  is  especially  noticeable.  "The  higher 
the  degree  of  thyroid  inadequacy,  the  greater  the  menstrual 
losses."  (Hertoghe.) 

Many  a  case  of  severe  dysmenorrhea  has  an  important 
thyroid  element  in  its  causation,  and  this  factor  may  out- 
weigh all  the  other  associated  conditions.  These  cases 
nearly  always  show  one  or  more  of  the  other  symptoms  of 
thyroid  inadequacy,  and  the  success  of  thyroid  or  thyro- 
ovarian  therapy  (E.  Hertoghe,  Practitioner,  Jan.,  1915), 
will  be  the  best  proof  of  the  correctness  of  our  surmises. 

The  "Classic  Picture"  of  Hypothyroidism.  I  have  enu- 
merated many  symptoms  referable  to  thyroid  insufficiency, 
so  many,  in  fact,  that  a  catalogue  of  the  possible  symptoms 
of  this  disorder  used  to  render  the  cataloguer  open  to  ridi- 
cule !  The  fact  remains  that  they  may  all  occur  as  a  result 
of  this  disorder  though  we  may  not  find  more  than  three  or 
four  of  these  signs  in  one  case.  However,  it  is  by  no  means 
uncommon  to  find  an  individual  showing  what  might  be 
called  "a  classic  picture"  of  hypothyroidism — severe  head- 
aches, neuralgia,  "rheumatism,"  constipation,  ptosis,  skin 
disorders,  hypothermia,  chilliness  or  distinct  chills,  slight 
dyspnea  perhaps  better  referred  to  as  a  sense  of  undue 
oppression  on  the  slightest  effort,  asthenia,  mental  changes 
of  a  minor  character — as  loss  of  memory,  inability  to  con- 
centrate— menstrual  disturbances,  etc.,  etc. 

Such  cases,  heretofore  an  unmitigated  nuisance,  both  to 
their  relatives  and  their  physicians — for  too  often  they  have 
perambulated  from  one  physician's  office  to  another — may 
now  be  considered  as  of  unusual  profit,  for  their  treatment 
by  attention  to  the  necessary  hygienic  measures  plus  thy- 
roid therapy  very  often  means  results,  the  like  of  which  can- 
not be  obtained  in  any  other  manner.  Such  patients  are 
amazed  at  their  progress,  their  friends  see  changes  in  their 
features  and  their  "view  of  life,"  that  make  for  success  in 
practice. 

Let  us  not  allow  the  slightest  phase  of  minor  thyroid  dis- 
order to  pass  us  again ;  and  let  us  always  remember  that  if 
our  diagnosis  is  wrong  the  treatment  will  show  it! 


96  PRACTICAL  ORGANOTHERAPY 

SECTION  IV.     CHAPTER  3 

THE  MORE  SERIOUS  ORGANIC  THYROID 
DISEASES 


Like  most  organs  of  the  body,  the  thyroid  gland  may  be 
the  subject  of  both  hypertrophic  and  degenerative  diseases. 
These  exert  a  well-marked  influence  upon  the  physiological 
activities  of  the  organism,  not  merely  due  to  the  effects  of 
the  disease  per  se,  but  more  particularly  because  of  the 
widespread  but  subtle  effects  of  the  resulting  dyshor- 
monism. 

Thyroid  Tumors — Goitre.  The  thyroid  gland  is  commonly 
the  seat  of  changes  which  result  in  the  production  of 
tumors,  and  while  the  organic  disorders  such  as  carcinoma 
and  sarcoma  are  somewhat  rarely  found  in  this  gland,  it  is 
considerably  more  frequently  modified  by  a  tumor  growth 
known  as  an  adenoma,  which  may  or  may  not  become  malig- 
nant. It  should  be  understood  that  these  tumors  may  be 
present  with  no  decided  change  in  the  internal  secretory 
capacity  of  the  gland,  while  on  the  other  hand  either  a 
reduced  or  an  increased  functional  activity  may  accompany 
the  development  of  the  new  growth.  This  change  in  endo- 
crine capacity  may  be  determined  by  my  Thyroid  Function 
Test.  (See  Chapter  4  of  this  Section.) 

Quite  the  most  common  tumors  of  the  thyroid  gland  are 
the  well-known  goitres.  Doubtless  much  of  the  mist  that 
has  surrounded  these  growths  in  the  past  has  resulted  from 
our  inability  to  distinguish  between  the  different  kinds  of 
goitre.  The  number  of  investigators  of  this  subject  has 
beenjarge,  and  the  amount  of  the  work  done,  stupendous; 
but  it  is  not  fitting  here  to  attempt,  more  than  briefly,  to 
mention  a  few  facts  recently  developed  and  to  tabulate  the 
symptoms,  characterizing  the  several  kinds  of  goitre. 

First,  let  us  remember  that  goitres  are  of  two  kinds, 
simple  adenoma,  furnishing  no  characteristic  symptoms — 
mere  hypertrophy  of  the  gland.  In  this  case  the  enlarge- 
ment seems  not  to  interfere  with  the  normal  functioning 
of  the  gland ;  however,  after  existing  thus  for  a  number  of 
years,  without  known  cause  and  with  or  without  increased 
hypertrophy  it  seems  to  furnish  an  increasing  amount  of 
the  normal  internal  secretion,  of  which  thyroxin  is  the 
active  principle,  attended  with  symptoms  of  hyperthyroid- 
ism.  If  not  interfered  with,  this  hyperthyroid  activity  may 


SERIOUS  THYROID  DISEASES 


97 


take  on  serious  proportions,  and  tends  to  grow  worse, 
finally  becoming  fatal.  In  this  stage  the  symptomatology 
does  not  diff er  from  that  of  exophthalmic  goitre,  save  in  a 
few  particulars.  Since  this  kind  of  hyperthyroidism,  as  is 
already  stated,  is  superadded  to  a  simple  hypertrophy  of 
the  thyroid  gland  which  has  existed  for  a  number  of  years 
(from  five  to  twenty),  these  more  serious  symptoms  are 
not  found  until  middle  life  or  afterward.  This  may  account 
for  the  additional  fact  that  here  strain  upon  the  heart, 
caused  by  hyperthyroidism,  becomes  more  and  more  serious 
causing  first  hypertrophy  and  dilatation  and  finally  disin- 
tegration of  the  heart  muscles.  Sometimes  these  simple 
adenomas  remain  throughout  life  without  developing  dan- 
gerous symptoms. 

Differential  Diagnosis  of  Hyperthyroidism 


ADENOMA— THYROTOXIC 

Non-hyperplastic — save  in  rare 
exceptions. 

Metabolism  —  B.  M.  R.  —  In- 
creased, direct  result  of  Hy- 
perthyroidism. Average  time 
after  beginning  of  tumor  un- 
til the  onset  of  symptoms — 
14  years. 

Exophthalmos  almost  never 
found. 


Systolic  B.  P.  averages  higher, 
also  diastolic. 

Seldom  appears  before  middle 
age. 

Beginning  gradual.  Often  un- 
able to  tell  exact  time  when 
symptoms  began. 

Broken  compensation  and  myo- 
cardial  disintegration  common 
in  later  stages — perhaps  be- 
cause incidence  is  later  in  life. 


EXOPHTHALMIC  GOITRE 

True  Hyperplasia  —  uniformly 
found. 

Metabolism  —  B.  M.  R.  —  In- 
creased, direct  result  of  Hy- 
perthyroidism. Average  time 
after  beginning  of  tumor  un- 
til the  onset  of  symptoms — 
11  months. 

Exophthalmos  occurs  in  87%  of 
cases  that  have  existed  two 
years  —  (50%  in  cases  less 
than  3  months  duration.) 

Tendency  to  hypertension  not 
usually  found. 

Average  incidence  5  or  10  years 
or  more,  before  middle  age. 

Onset  rather  abrupt  —  date  of 
commencement  often  can  be 
given. 

Compensation  in  heart  action 
common. 


Differential  Diagnostic  Points.  In  the  other  form  of 
goitre,  known  as  exophthalmic  goitre,  the  tumor  undergoes 
hyperplasia,  or  the  growth  of  new  cell  elements  within  the 
tumor.  Unlike  the  adenoma  this  hyperplastic  enlargement 
is  attended  almost  from  the  first  by  symptoms  of  hyper- 
thyroidism and,  as  in  the  more  dangerous  forms  of  adenoma, 
these  symptoms  grow  worse  and  worse  with  no  tendency 


98  PRACTICAL  ORGANOTHERAPY 

toward  a  spontaneous  cure.  The  chief  differences  between 
the  hyperthyroidism  of  adenoma  and  that  of  exophthalmic 
goitre  are  that  (1)  these  untoward  symptoms  develop  soon 
after  the  beginning  of  the  enlargement  of  the  thyroid  and 
(2)  since  the  subjects  are  usually  younger  than  those  in 
whom  the  adenoma  becomes  dangerous  in  middle  life,  the 
effect  upon  the  muscles  of  the  heart  is  not  so  serious,  doubt- 
less because  the  subjects,  being  younger,  can  better  endure 
the  overwork  of  the  heart. 

Simple  Goitre.  The  so-called  "simple  goitre"  may  be  of 
three  distinct  types:  (a)Parenchymatous  (increased  pro- 
liferation of  the  thyroid  structure  and  follicles)  in  which 
case  the  gland  is  moderately  firm  to  the  touch  and  regular 
in  form;  (b)  colloid  (increased  production  of  the  material 
in  the  follicles)  with  a  comparatively  large  and  soft  tumor ; 
and  (c)  cystic  (a  modification  similar  to  the  colloid  form  in 
which  the  follicular  contents  are  fluid)  in  which  there  is  a 
distinct  fluctuation  present. 

With  these  several  forms  of  simple  goitre  there  are  often 
no  important  general  symptoms,  although  one  must  expect 
to  find  local  disturbances  depending  upon  the  degree  of  pres- 
sure that  may  be  exerted  by  the  enlarged  gland.  It  can  be 
readily  understood  that  the  intrathyroid  changes  may 
diminish  the  secretory  powers  of  the  glandular  tissue,  whilst 
the  hypertrophy  causes  a  considerable  increase  in  the  size 
of  the  gland.  This  explains  the  presence  of  hypothyroid- 
ism  in  goitre  and  also  the  occasional  value  of  thyroid 
therapy  in  goitre,  for  as  Falta  says:  "For  the  most  part 
there  is  sufficient  parenchyma  capable  of  functionating." 
When  this  comparatively  healthy  portion  of  the  gland  is 
not  enough  to  supply  the  necessary  amount  of  hormones, 
the  homo-stimulant  action  of  the  thyroid  which  may  be 
administered,  suffices  to  increase  the  functional  activity  of 
the  healthy  remainders  and  thus  augment  the  deficiency 
with  resulting  clinical  benefit. 

Thyrotoxicosis  and  Adenomata.  With  the  simple  form  of 
goitre  there  are  often  no  important  symptoms,  and,  as  sug- 
gested, the  goitre  may  continue  for  many  months  or  years 
without  manifesting  any  unusual  irritability  until  life  ends 
from  some  other  cause;  but  too  often  in  middle  life,  as 
already  suggested,  without  any  known  cause  and  without 
any  apparent  change  of  internal  structure  of  the  tumor,  the 
apparently  normal  thyroxin  may  be  furnished  in  increased 
quantities  until  the  system  is  thoroughly  poisoned,  the  con- 
dition being  known  as  thyrotoxicosis.  Or,  again,  the  sound 


SERIOUS  THYROID  DISEASES  99 

secretory  portions  of  the  gland  may  hypertrophy  and  a 
condition  of  hypersecretion  supervene — in  which  event  the 
clinical  diagnosis  is  not  usually  made  by  the  local  examina- 
tion, but  rather  by  the  study  of  the  manifestations  of  dys- 
hormonism  which  accompany  the  goitre,  and  which  will  be 
referred  to  shortly. 

The  well-defined  and  localized  goitres,  or  adenomata,  com- 
monly have  a  distinctly  nodular  feeling.  Where  there  is  an 
accompanying  syndrome  which  includes  anemia  and 
cachexia,  suspicions  of  malignancy  are  warranted.  The 
confirmation  of  such  suspicions  is  usually  made  after  an 
operation,  although  occasionally  the  presence  of  metastatic 
growths  is  convincing  though  belated  evidence  of  the  malig- 
nant character  of  the  tumor. 

Thyroiditis.  The  thyroid  gland  may  be  the  subject  of  an 
acute  infectious  process  of  varying  severity.  This  has  been 
seen  to  follow  an  infective  process  elsewhere  in  the  body, 
particularly  in  the  tonsils,  as  well  as  a  number  of  the  acute 
infectious  diseases.  Not  infrequently  it  occurs  in  the  pri- 
mary stage  of  syphilis.  From  a  diagnostic  standpoint  the 
most  important  findings  in  acute  thyroiditis  include  the 
rapid  onset  and  well-defined  enlargement  of  the  gland  with 
extreme  local  tenderness,  exquisite  pain  extending  up  and 
out  of  the  throat,  ears  and  neck,  fever,  the  results  of  in- 
creased thyroid  function — especially  cardiac,  and,  in 
advanced  cases,  pus  formation  with  fluctuation. 

Sclerotic  changes  may  follow  an  acute  inflammatory 
process  and  are  not  uncommonly  also  seen  in  tuberculosis, 
syphilis  and  alcoholism.  The  direct  result  of  this  condition 
is  likely  to  be  a  varying  degree  of  hypothyroidism  (dis- 
cussed in  the  previous  chapter)  which  even  may  become  a 
well-defined  myxedema. 

Myxedema.  The  organic  changes  in  the  thyroid  just 
mentioned  are  less  frequent  than  these  functional-organic 
changes  which  differ  from  the  minor  thyroid  disorders 
already  outlined,  only  in  degree.  The  well-defined  and 
chronic  secretory  disturbances  of  the  thyroid  gland  are 
practically  always  accompanied  by  structural  changes,  in- 
sufficiency being  associated  with  sclerosis  or  atrophy 
(though  as  we  have  seen,  goitre  is  commonly  accompanied 
by  hypothyroidism)  and  increased  activity  with  hyper- 
trophy and  increased  vascular  engorgement. 

The  first  of  these  is  myxedema  or  organic  hypothyroid- 
ism. We  have  already  seen  that  this  may  be  of  very  slight 
degree  with  a  large  series  of  inconspicuous  symptoms.  It 


100  PRACTICAL  ORGANOTHERAPY 

may  be  more  marked — the  "myxedeme  fruste"  of  Hertoghe 
— or,  again,  it  may  be  so  well  established  that  the  thyroid 
aplasia  results  in  a  typical  myxedema,  the  symptomatology 
of  which  we  now  may  discuss  briefly.  Incidentally  the  dis- 
order known  as  cretinism  is  really  an  early  myxedema  or 
athyroidia,  and,  save  for  the  well-defined  development  dis- 
turbances due  to  the  earlier  lack  of  the  thyroid  hormones, 
the  symptoms  are  practically  the  same. 

Naturally,  one  would  expect  to  find  a  similarity  between 
the  manifestations  of  myxedema  and  the  minor  form  of 
hypothyroidism,  and  this  is  the  case,  the  difference  being 
chiefly  in  degree.  The  changes  in  the  skin  are  most  obvious 
and  it  is  due  to  their  prominence  that  the  disease  received 
its  name.  They  are  dependent  upon  the  condition  of  infil- 
tration or  edema  (this  is  not  really  edema,  for  the  infil- 
trated products  are  mucoid  rather  than  fluid  and  there  is 
no  pitting  on  pressure),  which  causes  well-marked  trophic 
changes  in  the  skin  itself,  as  well  as  in  the  dermal  append- 
ages. The  color  of  the  skin  is  a  buff -pink,  sometimes  almost 
grayish.  It  is  said  by  some  to  look  like  alabaster.  It  is 
puffy,  dry,  desquamates  easily,  and  the  sweat  glands  are 
inactive.  The  skin  is  often  unusually  susceptible  to  local 
infections.  The  hair  is  dry  and  brittle  and  falls  out  in 
large  quantities.  The  nails  crack  easily  and  are  dry  and 
poorly  nourished.  The  teeth  are  almost  invariably  in  very 
bad  order. 

The  vital  processes  as  a  whole  are  reduced  to  a  minimum. 
The  temperature  is  from  one  to  several  degrees  below  nor- 
mal, metabolism  is  reduced  and  with  it  the  elimination  of 
wastes  by  all  channels.  Toxemia  is,  therefore,  the  rule  and 
this  favors  a  condition  of  invincible  constipation  which  is 
also  usually  present.  Despite  this  toxemia  the  heart  action 
is  usually  reduced  with  a  slow  pulse  and  a  tension  often 
much  below  normal,  due  to  the  associated  adrenal  insuffi- 
ciency which  will  be  considered  in  another  chapter.  As  a 
further  result  of  this  there  is  a  well-marked  anemia  and 
especially  a  hemoglobin emia. 

The  retrograde  changes  in  the  mental  powers  are  very 
marked,  in  fact  the  whole  of  the  nervous  system  is 
extremely  inactive.  The  reaction  of  the  body  to  external 
stimuli  is  very  poor.  Mentality  may  vary  from  dullness  to 
complete  amentia,  and  in  early  cases,  loss  of  memory  and 
inability  to  concentrate  and  the  general  disinclination  to 
use  the  mental  powers  are  the  rule.  The  term  "logey"  is 
often  applied  to  these  cases. 


SERIOUS  THYROID  DISEASES  101 

Impotence  is  the  rule  in  men,  and  in  women  either 
amenorrhea  or  menorrhagia.  (In  the  first  instance  the 
gonads  lack  the  stimuli  from  the  thyroid  which  are  undoubt- 
edly a  factor  in  establishing  and  maintaining  the  molimena, 
while  in  the  latter  the  infiltration  of  the  myometrium  and 
endometrium  coupled  with  a  subtle  change  in  the  chemistry 
of  the  blood  may  cause  an  increased  and  prolonged  mens- 
trual flow.)  Atrophy  of  the  genitalia  may  take  place,  but  is 
not  so  marked  as  in  pituitary  disease,  of  which  more  later. 

Cretinism.  In  infantile  myxedema  or  sporadic  cretinism, 
in  addition  to  the  findings  previously  mentioned,  there  is  an 
almost  entirely  retarded  mentality  and  physical  backward- 
ness and,  of  course,  the  sexual  development  is  practically 
stopped.  The  face  has  a  broad,  puffy,  "sloppy"  appearance, 
the  "saddle  nose"  is  frequent,  and  the  capacity  to  respond 
by  a  smile,  a  twinkle  of  the  eye,  or  motions  of  the  facial 
muscles,  is  almost  entirely  lost — but  this  is  mental,  as  suit- 
able tests  will  show  no  paralysis  present.  The  mouth  hangs 
open,  the  lips  are  large  and  the  teeth  are  delayed  in  their 
eruption,  and  when  seen  are  carious  and  widely  spaced.  The 
bones  are  abnormally  formed,  short  and  stubby.  The  figure 
is  deformed,  the  gait  awkward,  and  sometimes  walking  is 
impossible.  Coordination  is  poor.  The  abdomen  is  soft  and 
prolapsed,  the  condition  known  as  "pot-belly"  being  fre- 
quent. The  cretin  does  not  grow  up  and  the  mental  and 
physical  stigmata  make  a  pitiable  picture. 

The  general  metabolic  inactivity  favors  the  deposit  of  fat 
and  the  condition  of  thyroid  obesity  is  quite  common  in 
cretinism  as  in  the  minor  hypothyroid  insufficiencies. 

A  word  should  be  added  here  about  "endemic"  cretinism 
as  compared  with  the  "sporadic"  form  just  mentioned.  This 
condition  is  extremely  rare  in  the  United  States,  but  com- 
mon in  Switzerland  and  Austria.  The  distinction  lies  in  the 
heredity:  endemic  cretins  are  descended  from  cretin  fam- 
ilies and  are  born  in  places  where  cretinism  is  prevalent. 
The  clinical  manifestations  are,  perhaps,  not  always  so  com- 
pletely typical  as  in  the  sporadic  form,  and  occasionally  pro- 
creation is  possible.  In  addition  to  the  stigmata  of  cretin- 
ism already  outlined,  umbilical  hernia  is  very  common  in 
the  endemic  form  of  cretinism.  Deaf-mutism  is  very  often 
associated  with  thyroid  aplasia.  According  to  Scholz  nearly 
30  per  cent,  of  the  endemic  cretins  seen  by  him  were  deaf 
mutes. 

There  is  another  important  distinction  between  these  two 
forms  of  cretinism — the  sporadic  form  responds  wonder- 


102  PRACTICAL  ORGANOTHERAPY 

fully  to  thyroid  medication,  while  the  endemic  form  may  or 
may  not  be  benefited  by  this  method  of  treatment. 

Hyperthyroidism*.  The  other  principal  form  of  thyroid 
dyscrasia  is  hyperthyroidism,  and  is  the  best  known  and 
most  complex  of  all  the  functional  thyroid  diseases.  Here 
the  thyroid  gland  is  unusually  active  with  or  without  a 
marked  increase  in  its  size.  This  condition  is  most  com- 
monly called  "exophthalmic  goitre,"  though  an  excessive 
thyroid  secretion  may  be  present  without  the  exopthalmos, 
and,  rarely,  the  exophthalmos  may  be  present  without  the 
goiter.  Parenthetically,  the  use  of  a  physician's  name  to 
identify  this  disease  is  confusing.  Parry  discovered  the 
syndrome  first  (1786).  Flajani  described  it  again  later. 
Graves  explained  the  syndrome  intelligently  (1835),  while 
von  Basedow  (1843)  gave  a  better  description  and  connected 
the  disorder  more  definitely  with  its  real  cause. 

A  few  words  as  to  the  principal  causes  of  this  complex 
disease  may  facilitate  our  study  of  its  diagnosis.  Three 
great  factors  must  be  taken  into  consideration :  Focal  infec- 
tions; fright  and  emotional  affections  and  the  hereditary 
thyroid  instability  so  well  emphasized  by  Leopold  Levi  and 
discussed  previously.  Fright  and  excessive  emotions  are 
not  uncommonly  connected  with  the  onset  of  a  severe  degree 
of  exophthalmic  goitre  and  Cannon's  recent  researches  into 
the  relation  of  the  emotions  to  adrenal  excitation  may  be 
the  basis  of  a  satisfactory  explanation  as  to  how  this  is 
caused.  For  instance,  it  is  quite  possible  that  the  undue 
stimulation  of  the  adrenals  thus  brought  about  may  so 
decidedly  push  the  thyroid  pendulum  as  to  cause  it  to  swing 
very  much  more  rapidly  and  widely  than  is  normally  the 
case,  while  the  resulting  dyshormonism  may  prolong  the 
effects,  for  the  thyroid  itself  is  just  as  susceptible  to  the 
thyroid  hormones  in  the  blood  as  are  any  of  the  other  organs 
of  the  body. 

Toxemia,  usually  of  bacterial  origin,  is  probably  the  most 
common  cause  of  this  disease,  and  a  careful  study  very  often 
will  reveal  some  focus  of  infection  in  one  part  of  the  body 
or  another.  Most  common  among  these  sources  of  bacterial 
poisoning  are  the  tonsils,  nasal  fossae  and  adjoining  sinuses, 
teeth  and  gums  (and  especially  around  the  roots  of  the 
teeth),  colon  (especially  the  angles),  gall  bladder  and  pelvic 


*  The  first  issue  (Jan.,  1921)  of  Harrower's  Monograhs  on  the 
Internal  Secretions  is  entitled  "Hyperthyroidism:  Medical  Aspects." 
It  contains  a  comprehensive  study  of  the  subject  with  bibliography. 
(120  pages;  sewed;  $1.50,  postpaid.  Annual  subscription,  $3.00.) 


SERIOUS  THYROID  DISEASES  103 

organs;  probably  in  the  order  mentioned.  Undoubtedly 
there  is  also  a  connection  between  the  incidence  of  hyper- 
thyroidism  and  the  gonads,  especially  in  women,  and  the 
frequency  of  this  disease  in  women,  about  10  to  1,  and  the 
common  relationship  of  menstrual  disturbances  with  it,  and 
vice  versa,  are  sufficient  confirmation  of  this.  That  these 
gonad  disorders  are  usual  in  individuals  with  that  subtle 
disorder  named  "I'instabilite  thyroidine"  and  that  an 
hereditary  defective  thyroid  substratum  favors  the  onset 
of  dysthyroidism,  is  well  borne  out  by  those  who  are  in  the 
habit  of  making  a  thorough  anamnesis. 

Aside  from  the  two  symptoms  embodied  in  the  name — 
exophthalmos  and  goitre — symptoms  which  we  need  not 
dilate  upon  here,  the  most  obvious  diagnostic  finding  is  the 
serious  change  in  the  heart  action.  Tachycardia  is  prac- 
tically the  rule,  the  pulse  ranging  from  120  to  180  beats  per 
minute.  With  this  is  an  extreme  degree  of  nervous  irrita- 
bility or  sympatheticotonus,  a  good  part  of  which,  in  the 
estimation  of  the  writer,  is  due  to  the  functional  adrenal 
and  circulatory  changes,  although  there  are  cases  in  which 
these  nervous  manifestations  have  nothing  to  do  with  the 
heart.  The  cardiac  excitability — it  is  often  of  a  heaving, 
pounding  nature — is  responsible  for  the  pulsation  not 
merely  of  the  goitre  itself,  but  of  various  vessels  through- 
out the  body,  and  this  persistent  beating  in  the  head,  the 
abdomen  and  especially  the  throat  and  neck  is  a  very  uncom- 
fortable symptom.  The  undue  strain  on  the  heart  often 
causes  dilatation  and  even  incompetency.  Myocarditis  is  the 
most  common  and  serious  result.  Some  writers  mention  the 
auscultation  of  a  murmur  over  the  goitre. 

As  might  be  expected,  the  metabolism  is  decidedly  plus. 
(See  especially  the  references  to  various  laboratory  tests  in 
Chapter  12  of  this  section.)  All  the  cells  are  working  over- 
time as  a  result  of  the  excessive  thyroid  stimuli  and  this  is 
doubtless  responsible  for  the  hyperthermia  which  is  quite 
common  in  the  well-marked  cases  of  this  disease.  It  also 
accounts  for  the  loss  of  weight  (despite  the  not  infre- 
quently increased  appetite  and  intake  of  food) ,  the  increased 
perspiration  and,  probably,  for  the  sharpened  mental  activ- 
ities. In  this  connection  one  of  the  difficult  features  of 
hyperthyroidism  is  the  control  of  the  mental  status  with  its 
disturbances  of  concentration  in  work  and  its  effects  upon 
insomnia.  It  has  been  remarked  by  several  writers,  and 
especially  by  Leonard  Williams,  of  London,  that  among  the 
earliest  signs  of  excessive  thyroid  action  is  a  tendency  to 


104  PRACTICAL  ORGANOTHERAPY 

genius — such  individuals  have  great  ideas,  lean  to  literature 
or  the  arts,  take  up  fads,  and  are  far  from  dull  in  their 
studies  or  their  work. 

With  the  decided  effects  of  myxedema  upon  the  skin  in 
mind,  one  would  expect  some  opposite  changes  in  the  skin 
in  this  opposite  condition,  and  this  is  the  case.  The  skin  is 
usually  thin  and  delicate,  is  moist  and  well-nourished  by  a 
very  good  blood  supply.  The  skin  reddens  under  the  slight- 
est local  or  emotional  influence  and  the  sweat  glands  become 
active  on  the  least  provocation  until  the  hyperidrosis  is 
more  than  a  nuisance.  Occasionally  this  is  one  of  the 
earliest  symptoms  and  night  sweats  of  thyroid  origin  have 
led  the  diagnostic  scent  away  from  the  right  trail. 

The  toxemia,  sympathetic  irritability  and  cardio-vascu- 
lar  excitability  together  form  a  combination  which  may  pro- 
duce many  and  varied  symptoms  only  a  few  of  which  need 
be  enumerated,  i.  e.,  tremor,  twitchings  of  the  eyelids  and 
face,  restlessness,  insomnia  and  often  a  decided  neuras- 
thenia. Myasthenia  with  an  aggravating  fatigue  and  much 
discomfort  on  exertion  are  usual  and  to  be  expected  in  a 
disease  in  which  the  hormonic  balance  is  so  thoroughly  dis- 
organized. 

The  late  symptoms  of  exophthalmic  goitre  include  serious 
heart  changes  both  in  the  sounds  and  the  rhythm.  Heart 
failure  is  a  common  cause  of  death  from  this  disease. 
Dyspnea  and  severe  diarrhea  are  also  ominous  signs  when 
found  accompanying  other  signs  of  hyperthyroidism. 


SECTION  IV.     CHAPTER  4 
A  METHOD  OF  TESTING  THYROID  FUNCTION 


Many  times  the  reaction  of  an  individual  to  organotherapy 
serves  as  a  fairly  good  index  to  the  condition  of  the  endo- 
crine glands  which  correspond  to  the  gland  from  which  the 
extract  was  made.  That  is  to  say,  individuals  with  a  sensi- 
tiveness in  a  given  gland  are  likely  to  react  more  quickly  to 
organotherapy  than  those  in  whom  there  is  an  apathy.  This 
is  more  particularly  true  of  the  thyroid,  and  many  hundreds 
of  physicians  have  given  thyroid  extract  to  patients  and  in 
a  short  time  had  to  discontinue  it  because  it  made  them 
nervous  and  irritable,  unduly  stimulated  the  heart  and  evi- 
dently was  not  accomplishing  what  was  desired. 


THYROID  FUNCTION  TEST  105 

Routine  Thyroid  Feeding.  Based  upon  a  number  of  clin- 
ical experiences  of  this  character,  I  have  devised  a  very 
simple,  but  none  the  less  useful,  method  of  testing  thyroid 
function,  which  was  announced  originally  in  the  New  York 
Medical  Record,  August  3rd,  1918.  The  test  consists  of 
giving  definite  and  increasing  doses  of  thyroid  extract,  with 
a  suitable  inert  excipient,  in  a  uniform  and  routine  manner, 
while  a  careful  study  is  made  of  the  pulse,  and  any  other 
symptoms  which  may  occur.  The  information  obtainable 
in  this  manner  is  of  much  service,  for  it  amounts  virtually 
to  a  differential  diagnostic  measure  in  the  study  of  goitre. 

It  will  be  recalled  that  from  the  secretory  standpoint 
there  are  two  distinct  varieties  of  goitre:  (1)  the  simple 
enlargement  of  the  gland,  which  appears  to  be  an  effort  on 
the  part  of  the  organism  either  to  supply  an  increased  de- 
mand for  its  particular  product  which  may  be  deficient,  or 
to  produce  a  greater  supply  than  usual  because  of  an  in- 
creased demand  for  it;  and  (2)  the  hypertrophy  which  is 
due  to  some  extra-glandular  cause,  such  as  toxemia  or  any 
form  of  irritation.  The  former,  or  simple  goitres,  are  a 
useful  attempt  on  the  part  of  the  body  to  render  the  best 
service  possible  under  the  circumstances  and  usually  are 
benefited  by  a  course  of  treatment  which  includes  the  ad- 
ministration of  thyroid,  iodin,  etc.,  which  thus  tends  to 
supply  the  need,  in  part  at  least,  and  render  the  friendly 
enlargement  of  the  gland  unnecessary.  Parenthetically,  in 
these  cases  of  simple  goitre,  the  administration  of  Iodized 
Thyroid  Co.  (Harrower),  which  contains  a  suitable  dose 
of  thyroid  extract,  iodide  of  iron  and  nuclein,  serves  very 
satisfactorily  to  supply  the  right  kind  of  stimuli  in  such 
circumstances. 

In  the  other  class  of  cases,  however,  the  conditions  are 
decidedly  different,  for  the  thyroid  gland  is  being  over- 
worked, and  driven  faster  than  normal.  This  is  usually 
brought  about  (1)  by  the  toxins  absorbed  from  foci  of  in- 
fection, (2)  from  emotional  disturbance  or  (3)  from  de- 
ranged functions  of  some  of  the  other  endocrine  glands. 
In  such  cases,  the  thyroid  gland  is  more  sensitive  and  hence 
more  unruly;  and  just  as  the  hypertrophy  differs  very  ma- 
terially in  origin,  so  it  differs  in  its  responsiveness  to  thy- 
roid treatment.  In  fact,  what  would  be  most  beneficial  in 
simple  goitre  would  be  most  detrimental  in  the  goitre  due  to 
hyperthyroidism,  and  the  administration  of  my  Thyroid 
Function  Test  enables  one  to  differentiate  the  early  func- 
tional stages  of  thyroid  sensitiveness,  i.  e.,  between  latent 


106 


PRACTICAL  ORGANOTHERAPY 


hypo-  and  hyperthyroidism,  and  thus  accomplish  something- 
worth  while  in  the  treatment. 

The  materials  for  the  thyroid  function  test  consist  of  four 
doses  each  of  a  half,  one  and  two  grains  of  thyroid  in  grad- 
uated capsules  together  with  a  chart  similar  to  the  one 
illustrated  (Fig.  1),  to  which  is  attached  printed  instruc- 
tions as  follows : 


Name 


Date 

PtJLSE   CHART 
Address 


3 

C 

9 

9 

12 

3 

6 

9 

9 

12 

3 

6 

9 

9 

12 

3 

6 

9 

9 

12 

3 

6 

9 

9 

12 

3 

:ieo 

150 

X 

•> 

\ 

140 

i 

} 

130 

3 

^ 

120 

no 

100 

90 

80 

70 

60 

50 

.Cmrij*  191$  ky  Htan  K  hUtrow  M.  D..U.  Aoftto.  C*l , 

Instructions  for  Using  the  Test.  Each  package  of  Thyroid 
Testing  Capsules  contains  12  capsules  of  three  graduated 
strengths  and  sizes.  A  pulse  chart  accompanies  each,  with 
explicit  instructions  as  to  how  to  fill  out  the  record. 

After  the  consultation,  at  which  the  first  pulse-counting 
is  done  and  recorded,  the  patient  counts  the  pulse  again  at 
6  and  9  o'clock;  and  the  following  morning  commences  to 
take  the  four  small  capsules  at  8,  10,  12,  and  2  o'clock  with 
a  swallow  of  water,  recording  the  pulse  five  times  a  day — 
at  9,  12,  3,  6,  and  9  o'clock.  On  the  second  day  the  four 
medium-sized  capsules  are  taken  at  similar  hours  and  the 
pulse  is  again  recorded  under  as  nearly  identical  conditions 
as  possible,  and  at  the  same  hours. 

During  the  third  day  the  four  large  capsules  are  taken  at 
the  same  hours  as  previously  and  the  pulse  is  again  recorded 
as  before.  The  fourth  day,  or  the  "first  day  after"  finishing 
the  ingestion  of  the  capsules,  the  pulse  is  recorded  as  before 
and  again  during  the  forenoon  of  the  fifth  day  ("second  day 
after")  when  the  chart  is  completed  (and  plotted,  if  con- 
venient), the  physician  is  consulted  and  the  data  thus 
secured  carefully  studied. 


THYROID  FUNCTION  TEST 


107 


It  is  important  to  watch  for  symptoms  such  as  irritability 
(temperamental  or  nervous),  twitchings  (of  the  eyelids, 
fingers,  etc.),  breathlessness  and  other  nervous  manifesta- 
tions. If  it  should  happen  that  on  the  second  or  third  days 
these  symptoms  are  present  and  prominent,  the  remaining 
capsules  should  not  be  taken;  but  the  chart  is  completed, 


6    9 


12 


9   12 


369 


9   12   3    6 


J60 
150 
140 
130 
120 
IIP 
100 

^90 
80 
70 

b__J 

CO 
50 


while  on  its  reverse  side  a  brief  statement  is  made  of  the 
symptoms,  giving  the  time  of  onset  and  other  related  facts. 

Note :  Take  the  pulse  under  as  nearly  uniform  conditions 
as  possible,  preferably  before  eating,  after  a  ten-minute  rest, 
and  sitting.  Mark  the  chart  in  the  proper  square  with  a  dot 
at  approximately  its  relative  position,  e.  g.,  72  would  be  just 
above  the  70-line,  86  would  be  about  the  middle  of  the  space 
between  the  80-  and  90-lines,  etc.  Be  regular  and  persistent. 
The  information  thus  obtained  is  worth  all  of  your  trouble ! 

The  Clinical  Reaction  to  the  Test.  The  reaction  of  the 
patient  to  this  routine  administration  of  uniform  doses  of 
thyroid  varies  very  materially,  depending  upon  the  factor 
that  we  are  attempting  to  discover.  In  the  apathetic 
hypothyroid  cases,  practically  no  difference  in  the  pulse 
figure  is  found,  and  as  in  these  cases  cardiac  action,  like 
practically  every  function  of  the  body,  is  lazy  and  slow,  the 
pulse  figures  are  low  and  remain  so. 

The  reaction  to  the  thyroid  testing  capsules  in  a  case  of 
functional  hypothyroidism  which  had  not  yet  advanced  to  a 
stage  where  the  usual  findings  of  myxedema  are  noted,  is 
nicely  illustrated  on  the  accompanying  chart  (see  Fig.  2). 
Here  it  will  be  noted  that  the  pulse  is  below  the  normal  and 
does  not  seem  to  be  influenced  whatever,  even  by  the  heavy 
dosage  of  thyroid  which  is  given  on  the  third  day. 

In  the  normal  individual,  on  the  other  hand,  the  thyroid 
feeding  is  going  to  temporarily  stimulate  the  thyroid  func- 


108 


PRACTICAL  ORGANOTHERAPY 


tion,  and  hence,  through  it,  the  heart  rate,  and  it  is  cus- 
tomary, during  the  third  day  of  taking  the  capsules,  for 
there  to  be  an  increase  in  the  pulse,  which,  however,  is  due 
to  the  administered  thyroid  extract  rather  than  to  any  ex- 
cess of  the  thyroid  hormone  which  may  be  produced  in  the 
body ;  and  since  these  products  are  destroyed  quite  rapidly, 


9    12 


12 


369 


3    6 


9   12   3    6 


JI60 
ISO 
140 
130 
120 
110 
100 
_90 
80 


60 


50 


the  cardio-stimulant  action  merely  lasts  during  the  time  of 
the  greatest  dosage  of  thyroid  and  comes  down  to  normal 
again  the  day  after. 

On  the  other  hand,  in  the  various  stages  of  thyroidism, 
the  pulse  findings  are  characteristic:  the  greater  the  sus- 
ceptibility, the  wider  the  range.  First  of  all,  as  will  be  noted 
in  the  accompanying  chart  (Fig.  3),  the  average  pulse  rate 
is  somewhat  higher  than  normal,  and  there  is  also  more 
irregularity  than  usual.  Early  in  the  administration  of  the 
thyroid,  the  pulse  begins  to  be  more  rapid  until,  during  the 
height  of  the  temporary  gland  feeding,  it  may  reach  well 
above  any  possible  normal  figure — 100,  110  or  even  higher. 
Since  this  stimulus  is  not  entirely  due  to  the  product  which 
has  been  administered  but  to  the  increased  activity  of  the 
supersensitive  gland,  following  the  removal  of  the  medica- 
tion, i.  e.,  "the  day  after"  and,  "the  second  day  after,"  the 
pulse  still  remains  up  because  the  thyroid  is  working  over- 
time, as  is  indicated  very  clearly  on  the  chart.  In  fact,  in 
well  defined  hyperthyroidism  with  tachycardia  this  test 
should  not  be  used,  nor  need  it  be,  for  the  diagnosis  should 
be  clear  without  it,  and  in  latent  cases  in  which  there  is  an 
unexpected  degree  of  thyroid  sensitiveness,  it  will  be  noted 
that  the  routine  advice  calls  for  the  omission  of  the  last 
four  capsules — the  largest  dose — but  the  continuation  of  the 
pulse  tracing,  with  a  note  to  that  effect  upon  the  chart.  In 
such  cases,  the  variations  in  the  pulse  findings  will  not  be  so 


THYROID  FUNCTION  TEST 


109 


exaggerated,  merely  because  the  test  has  not  been  com- 
pleted, but  the  indications  are  equally  obvious  and  helpful. 
The  Discovery  of  Latent  Thyroid  Conditions.  This  test 
is  more  useful  in  the  discovery  of  thyroid  apathy  or  a  latent 
degree  of  thyroid  sensitiveness  than  in  the  diagnosis  of 


3    6 


9  1 12 


9jl2j_3 


9   12 


160 
150 
140 
130 
120 
HO 
100 


80 


TO 


60 


50 


frank  hyperthyroidism,  for  reasons  which  will  be  clear.  Two 
out  of  many  hundreds  of  cases  that  have  been  tested  in  this 
manner  showed  charts  which  were  quite  unexpected  and 
worthy  of  comment.  The  first  was  an  individual  with  a 
highly  nervous  attitude,  staring  eyes,  fine  tremor,  sweating 
palms  and  general  sympathetic  irritation.  He  was  sent  to 
me  as  a  "typical  case  of  hyperthyroidism,"  yet  some  of  the 
findings  were  missing,  especially  the  fact  that  the  pulse  was 
approximately  normal.  A  thyroid  function  test  was  made 
and  the  following  chart  secured  (Fig.  4),  and  later  an  X-ray 
examination  of  the  chest  showed  a  sub-clavicular  tumor  of 
considerable  dimensions.  The  sympathetic  irritation  was 
due  largely  to  the  pressure  of  this  intrathoracic  tumor,  and 
the  patient  did  not  have  "typical  hyperthyroidism"  after  all. 
Another  case  of  an  opposite  character  had  a  large  goitre 
which  was  about  to  be  operated  upon  for  cosmetic  reasons. 
The  physician  about  that  time  happened  to  hear  of  this  test, 
tried  it  and  later  sent  me  the  accompanying  chart  (Fig.  5), 
from  which  it  seemed  clear  that  the  patient  had  a  well- 
defined  degree  of  thyroid  inactivity,  and  at  my  suggestion 
various  other  symptoms  of  Hertoghe's  disease — "myxedeme 
fruste" — were  discovered,  the  patient  was  given  medication 
calculated  to  stimulate  the  thyroid  and  ovarian  functions, 
and  the  goitre  almost  disappeared  eventually,  and  the  men- 
strual difficulties,  which  were  quite  prominent,  were  con- 
trolled simultaneously.  In  this  particular  case,  the  thyroid 
function  test  saved  an  operation  by  giving  broader  informa- 
tion in  regard  to  the  patient. 


110 


PRACTICAL  ORGANOTHERAPY 


The  Test  in  Chronic  Disease.  Still  one  other  class  of 
cases  may  benefit  materially  from  the  use  of  this  test:  I 
refer  to  the  chronic  toxic  and  nutritional  disturbances  such 
as  rheumatism,  neurasthenia,  tuberculosis,  etc.,  in  which 


6  9 


9  12  3  6  9 


9  12  3  b 


160 
150 
140 
130 
120 

no 

100 
90 


elimination  is  very  much  below  par  and  there  seems  to  be 
a  radical  reduction  in  the  oxidizing  process.  In  such  cases, 
a  thyroid  function  test  may  indicate  a  marked  degree  of 
thyroid  apathy  and  direct  attention  to  the  possibility  of 
stimulating  this  deficiency,  with  decided  prospects  for  bene- 
fit from  the  obviously  necessary  thyroid  therapy.  It  is 
perfectly  true  that  many  such  cases  may  receive  benefit 
from  the  use  of  thyroid  extract  without  the  test,  but  there 
is  a  much  greater  satisfaction  in  having  a  definite  reason 
for  each  procedure  when  this  is  possible. 

My  reference  to  tuberculosis  calls  for  a  word  of  explana- 
tion and  caution:  Many  tuberculous  persons  have  a  well- 
defined  thyro-adrenal  insufficiency  (see  Sec.  V,  Chap.  2),  and 
the  thyroid  function  test  indicates  this  clearly;  so  do  the 
blood  pressure  and  the  uranalysis.  This  naturally  calls  for 
obvious  associated  gland  support  that  should  receive  atten- 
tion. On  the  other  hand,  since  the  thyroid  gland  is  expected 
to  react  to  stimuli  of  a  toxic  nature,  a  latent  degree  of 
hyperthyroidism  indeed  may  be  present  and  easily  discov- 
erable following  this  test,  in  which  case  any  glandular  treat- 
ment which  might  be  in  order  would  be  the  opposite  from 
that  given  to  the  other  tuberculous  persons  in  the  large  class 
mentioned  previously.  In  such  cases,  instead  of  using  the 
cell-stimulating  Adreno-Spermin  Co.  (Harrower),  a  prepa- 
ration containing  pancreas,  which  tends  to  neutralize  sym- 
pathetic irritability,  would  be  better  (see  Sec.  V,  Chap.  10). 

It  has  been  said  that  this  thyroid  function  test  is  nothing 


THE  ADRENAL  GLANDS  111 

but  the  administration  of  thyroid  extract  and  the  usual 
noting  of  the  patient's  reaction,  but  unfortunately  most  of 
our  experiences  of  this  character  have  been  our  failures, 
and  our  clearest  recollections  about  them  were  the  remarks 
made  about  the  uncomfortable  feelings  which  resulted  from 
the  administration  of  the  thyroid  extract  for  a  week  or 
two,  and  caused  us  to  stop  it  at  once.  Further,  the  fact  that 
this  test  is  ready  to  use,  that  there  are  printed  instructions 
and  a  chart  available,  directs  attention  to  and  makes  con- 
venient a  measure  which  ordinarily  may  not  be  thought  of; 
hence  I  feel  justified  in  emphasizing  the  importance  of  this 
procedure,  not  merely  in  the  differentiation  of  goitre  as 
indicated,  but  in  the  search  for  scientific  reasons  for  the  use 
of  thyroid  extract  as  a  part  of  the  treatment  in  a  given  case. 


SECTION  IV.    CHAPTER  5 

THE  ADRENAL  GLANDS  IN  HEALTH  AND 
DISEASE 


Perhaps  more  profitable  research  has  centered  around  the 
adrenal  glands  during  the  past  twenty  years  than  around 
any  of  the  other  glands  of  internal  secretion.  At  least 
many  epoch-making  discoveries  of  their  important  role 
have  been  made  quite  recently. 

Unfortunately,  the  clinical  application  of  this  new  knowl- 
edge has  not  been  very  extensive  as  yet;  and  many  times 
the  physician's  sole  appreciation  of  adrenal  disease  consists 
of  a  hazy  recollection  that  Addison's  disease  is  said  to  be  a 
tuberculous  involvement  of  the  adrenal  glands — and  that 
it  is  incurable. 

Some  things  about  the  adrenals  are  very  well  known. 
We  are  in  the  habit  of  using  adrenalin  almost  every  day  and 
know  that  it  exerts  a  decided  influence  upon  the  circulatory 
system,  both  in  physiology  and  in  therapeutics.  We  also 
know  that  the  adrenin  continuously  produced  by  the  adrenal 
medulla  is  the  principal  regulator  of  vascular  tone  and  that 
it  performs  a  number  of  other  useful  services  for  the  body. 
But,  somehow  or  another,  it  is  the  exception  to  find  a  proper 
clinical  appreciation  of  the  importance  of  the  work  of  the 
adrenals  and  how  easily  their  functions  may  be  influenced 
slightly  or  seriously  with  corresponding  minor  or  important 
effects  on  the  body  as  a  whole. 


112  PRACTICAL  ORGANOTHERAPY 

Fifteen  years  ago  T.  R.  Elliott,  of  London,  showed  us  that 
adrenin  virtually  controlled  the  autonomic  and  sympathetic 
nervous  systems.  Sergent,  of  Paris,  had  already  proved  this 
relationship  in  numerous  experiences  in  his  clinical  work. 
Still  more  recently  Cannon,  of  Harvard,  has  given  us  an  en- 
tirely new  conception  of  the  extreme  importance  of  adrenin 
to  the  human  economy  especially  in  so  far  as  its  variations 
are  related  to  the  emotions. 

Some  Points  About  Adrenal  Physiology.  A  brief  exposi- 
tion of  the  physiology  of  the  adrenal  glands  will  prepare  us 
for  a  better  understanding  of  their  secretory  disorders.  The 
chromaffin  hormone,  otherwise  known  as  adrenin,  arising 
from  the  medullary  portion  of  the  adrenals,  as  well  as  in 
other  chromophil  cell  collections  in  different  parts  of  the 
body,  exerts  a  very  remarkable  and  extended  influence  upon 
numerous  structures  which  are  controlled  by  the  sympa- 
thetic. Adrenin  raises  the  blood  pressure  and  has  much  to 
do  with  its  maintenance  at  the  average  level;  it  dilates  the 
pupils  and  excites  the  flow  of  tears  and  saliva;  it  contracts 
the  minute  muscles  of  the  hairs  (erectores  pilorum) ;  un- 
doubtedly it  is  concerned  with  the  function  of  the  sweat 
glands  and,  in  fact,  the  blood  supply  of  the  skin  and,  in 
addition  to  all  this,  it  seems  to  have  a  certain  influence  upon 
the  gastric,  uterine  and  intra-abdominal  muscles  in  general. 

Adrenin  is  probably  the  principal  factor  in  the  main- 
tenance of  the  normal  tone  of  the  body,  and  disturbances 
in  its  production  disorganize  the  so-called  "sympathetico- 
tonus,"  causing  it  to  be  deficient  or  abnormally  increased 
as  the  case  may  be.  The  condition  known  as  "adrenin  sen- 
sibility" is  now  being  used  as  the  basis  for  several  tests  for 
sympathetic  functioning  which  will  be  referred  to  later. 

The  adrenals  are  particularly  susceptible  to  what  have 
been  termed  the  "emergency  conditions."  Cannon's  well 
checked  experiments  have  definitely  proved  that  the  emo- 
tions, including  pain,  rage,  fear  and  hunger  (perhaps  it  will 
be  shown  later  that  even  worry  has  a  similar  effect)  influ- 
ence the  secretory  powers  of  the  adrenals,  with  an  imme- 
diate response  due  to  the  hyperadrenia  thus  produced.  This 
condition  passes  rapidly  because  adrenin  is  oxidized  with 
unusual  facility,  and  as  soon  as  the  glands  have  been  suf- 
ficiently overworked  and  the  stimulation  continues  with  no 
opportunity  for  recuperation,  a  serious  condition  of  hypo- 
adrenia  supervenes. 

While  comparatively  very  little  therapeutic  advantage 
has  been  taken  of  the  results  of  this  work,  we  can  now  see 


THE  ADRENAL  GLANDS  113 

rational  explanations  for  a  number  of  phenomena  which 
quickly  can  be  called  to  mind.  Practically  the  whole  of  the 
results  of  Crile's  investigation  of  "the  kinetic  system"  and 
his  now  fairly  well  known  method  of  "anoci-association"  are 
really  dependent  upon  the  prevention  by  suitable  measures 
of  any  undue  stimulation  of  the  adrenal  glands,  and  hence 
the  serious  consequences  of  acute  hypoadrenia  are  thereby 
forestalled.  It  will  be  recalled  that  Crile  emphasized  the 
fact  that  the  kinetic  system  embraces  the  adrenals,  thyroid, 
brain  and  muscles,  which  cooperate  to  "drive"  the  body. 
The  adrenals  are  probably  the  most  important  of  these 
kinetic  organs  and  the  method  of  pan-anesthesia  named 
"anoci-association"  consists  in  supplementing  the  usual  an- 
esthetic measures  by  removing  such  mental  and  nervous 
stimuli  (by  preventing  fear  and  pain  and  by  "blocking"  cer- 
tain nerves)  as  would  tend  to  stimulate  the  adrenals  and 
by  their  depletion  bring  on  shock  and  collapse. 

Before  considering  the  symptomatology  of  the  functional 
adrenal  secretory  dyscrasias,  it  should  be  recalled  that  not 
only  are  emotional  factors  already  referred  to  capable  of 
causing  this  adrenal  syndrome,  but  that  certain  of  the  hor- 
mones produced  in  other  organs,  when  present  in  the  blood 
stream  in  unusual  amounts  (see  further  references  to  this 
in  the  chapter  on  the  ovaries)  may  have  a  similar  stimu- 
lating effect.  We  must  also  remember  that  toxemia  of  in- 
testinal or  bacterial  origin  exerts  a  like  influence  and  that  it 
has  been  shown  that  conditions  associated  with  extremely 
high  blood  pressure  cause  adrenal  disorder,  probably  by 
producing  intra-adrenal  hemorrhages.  One  of  the  best 
established  "symptoms"  of  senility  is  of  adrenal  origin. 

With  these  facts  in  mind  we  can  understand  that  severe 
emotional  conditions,  sudden  or  prolonged;  acute  infectious 
diseases,  with  the  invariable  accompanying  toxemia;  and 
chronic  infections,  as  tuberculosis  or  intestinal  stasis  (which 
is,  after  all,  practically  a  chronic  infection  with  mechanical 
involvement  added)  would  be  likely  to  bring  about  certain 
changes  in  the  activities  of  the  organism  as  a  result  of  the 
influences  due  to  adrenal  derangement. 

Hyperadrenia.  Hyperadrenia  is  not  nearly  so  common  a 
symptom  as  hypoadrenia,  although  necessarily  just  as 
frequent,  for  the  adrenal  depletion  of  which  we  shall  shortly 
speak  is  really  a  terminal  condition  which  results  from  the 
exhaustion  following  excessive  stimulation.  The  reason 
that  hyperadrenia  is  not  more  commonly  detected  is  prob- 
ably due  to  the  fact  that  adrenin  is  oxidized  in  the  blood 


114  PRACTICAL  ORGANOTHERAPY 

with  great  rapidity,  and  that  if  large  quantities  of  it  hap- 
pen to  be  brought  forth,  they  are  destroyed  very  shortly 
after  they  are  produced.  Confirmation  of  this  destructive 
influence  is  noted  following  the  use  of  adrenalin  for  thera- 
peutic purposes,  as  well  as  in  many  experiments  on  animals 
which  uniformly  show  that  once  this  hormone  gets  into  the 
blood,  it  is  very  quickly  destroyed.  Incidentally,  this  is  also 
emphasized  by  the  fact  that  adrenalin  is  not  as  effective 
or  suitable  for  prolonged  adrenal  support  as  adrenal  sub- 
stance ;  for  while  adrenalin  undoubtedly  homostimulates  the 
adrenals,  it  does  so  suddenly  and  actively,  but  the  effects  are 
ephemeral;  while  on  the  other  hand,  the  use  of  the  total 
gland  favors  a  reestablishment  of  the  depleted  adrenal  func- 
tions, though  the  action  is  slower. 

It  will  be  proper  to  enumerate  several  clinical  findings 
which  are  probably  of  adrenal  origin,  since  the  treatment 
is  largely  preventive  rather  than  direct,  for  to  realize  that 
certain  factors  are  unduly  stimulating  the  adrenals,  is  to 
realize  that  these  factors  must  be  abated. 

An  unusual  tendency  to  goose  pimples,  without  any  ordi- 
nary reason  therefor,  may  be  directly  due  to  this  condition. 
Probably  this  accounts  for  the  not  uncommon  association 
of  this  phenomenon  with  fright.  Chills,  which  are  merely 
severe  vaso-motor  disturbances  with  muscular  spasm,  are 
commonly  produced  artificially  by  injections  of  adrenalin 
(especially  following  its  use  in  the  control  of  asthma),  and 
I  am  by  no  means  sure  that  this  chief  manifestation  of 
malaria  is  not  due  to  a  temporary  and  excessive  stimulation 
of  the  adrenal  glands  by  the  sudden  unloosing  of  the  toxins 
of  the  plasmodia.  Further,  the  severe  reaction  following 
this  positive  phase  of  malaria,  with  its  prostration,  asthenia 
and  depression,  stimulates  the  symptom  complex  of  hypoa- 
drenia,  as  we  shall  shortly  see. 

In  studying  the  relation  of  the  adrenal  glands  to  the  toxe- 
mia of  tuberculosis,  Pottenger  remarks  that  the  continued 
stimulation  of  the  adrenals  and  the  pouring  into  the  blood 
stream  of  minutely  increased  amounts  of  adrenin,  have  the 
effect  of  producing  a  prolongation  of  the  condition  which 
is  originally  brought  about  by  sympathetic  stimulation'.  It 
is  suggested  that  this  condition  of  hyperadrenia  is  respon- 
sible for  the  dry  mouth  frequently  seen  in  tuberculosis,  and 
that  other  symptoms  of  sympathetic  origin,  such  as  the 
sudden  and  seriously  impaired  digestion  and,  particularly, 
the  rapid  heart  action,  are  really  the  results  of  exces- 
sive adrenal  stimulation.  Without  a  doubt  hyperadrenia 


THE  ADRENAL  GLANDS  115 

unduly  stimulates  the  thyroid  and  vice  versa,  hence  the 
symptomatology  of  adrenal  excess  and  hyperthyroidism  is 
similar,  and  it  is  difficult  to  differentiate  the  origin  of  a 
given  disorder. 

It  is  quite  possible  that  certain  cases  of  purely  functional 
hypertension,  with  no  renal,  cerebral  or  vascular  findings 
demonstrable,  are  really  due  to  hyperadrenia,  usually  of 
toxic  origin.  At  least  the  interesting  though  academic  re- 
searches of  Zimmern  and  Cottenot,  of  Paris,  seem  to  con- 
firm this.  They  were  able  to  reduce  very  high  tensions  by 
properly  dosed  roentgenization  of  the  areas  over  the  adre- 
nals— to  my  mind  a  very  serious  undertaking.  Parenthet- 
ically, some  quite  profitable  studies  of  the  treatment  of 
functional  hypertension  have  been  based  upon  this  fact  and 
on  the  well  known  antagonism  exerted  by  the  pancreas  upon 
adrenal  function.  This  is  considered  more  in  detail  in  Sec- 
tion V,  Chapter  15. 

There  is  still  another  form  of  hyperadrenia  which  must 
be  mentioned  though  it  is  very  rare.  I  refer  to  the  con- 
dition known  as  "hypernephroma,"  which  is  an  excessive 
proliferation  of  the  adrenals  usually  involving  the  corticular 
tissue  more  than  the  medulla.  The  chief  manifestation  of 
this  is  a  remarkable  increase  in  the  development  and  growth 
in  early  life  (this  is  much  more  common  in  young  subjects) 
with  premature  sexual  development.  Bullock,  Sequeira  and 
others  have  demonstrated  a  relation  between  the  presumed 
internal  secretion  of  the  adrenal  cortex  and  the  gonads.  At 
all  events  in  cases  of  this  disease  the  findings  are  chiefly 
referable  to  the  gonad  functions — a  child  of  eight  or  nine 
may  be  quite  as  large  as  an  adult  with  marked  overdevelop- 
ment, physical  and  functional,  of  the  genitalia,  and  hyper- 
trichosis.  It  is  a  difficult,  practically  hopeless,  surgical 
condition. 

Adrenal  Insufficiency.*  Since  the  adrenals  are  so  ex- 
tremely susceptible  to  so  many  outside  influences  it  is  likely 
that  they  would  be  easily  "worn  out"  and,  as  a  matter  of 
fact,  functional  hypoadrenia  is  as  common  a  condition  as 
any  endocrine  manifestation.  From  a  practical  standpoint, 
this  is  an  extremely  important  symptom-complex. 

It  is  quite  some  years  since  Sajous  began  to  emphasize 
the  importance  of  this  condition,  and  while  his  opinions 
were  scouted  and  some  of  his  ideas  declared  visionary  it 
must  be  admitted  that  our  present  knowledge  of  this  sub- 
ject is  very  much  in  harmony  with  the  following  quotation 
from  Sajous'  monumental  work:  "Functional  hypoadrenia 


116  PRACTICAL  ORGANOTHERAPY 

is  the  symptom  complex  of  deficient  activity  of  the  adrenals 
due  to  inadequate  development,  exhaustion  by  fatigue, 
senile  degeneration,  or  any  other  factor  which,  without 
provoking  organic  lesions  in  the  organs  of  their  nerve  paths, 
is  capable  of  reducing  their  secretory  activity.  Asthenia, 
sensitiveness  to  cold  and  cold  extremities,  hypotension, 
weak  cardiac  action  and  pulse,  anorexia,  anemia,  slow  meta- 
bolism, constipation  and  psychasthenia  are  the  main  symp- 
toms of  this  condition." 

Hypoadrenia  is  a  complication  of  all  the  serious  acute 
infectious  fevers,  since  the  adrenals  are  so  intimately  con- 
nected with  the  "driving"  of  the  body  and  are  so  susceptible 
to  toxemia,  that  the  ultimate  reduction  of  the  accustomed 
adrenal  stimuli  is  responsible  for  a  slowing  down  of  many 
of  the  sympathetic-controlled  functions  of  the  organism. 
Too  often  this  sympathetic  asthenia  is  the  actual  cause  of 
death  from  disease  of  this  character. 

There  are  three  forms  of  hypoadrenia  which  differ  suffi- 
ciently from  one  another  to  be  discussed  separately: 

(1)  Functional  Hypoadrenia — a  temporary  deficiency  in 
the  production  of  the  chromaffin  hormone  is  shown  most 
frequently  by  a  tardy  response  of  the  circulatory  system 
to  its  accustomed  stimuli  and  the  development  of  a  condition 
of  circulatory  inefficiency,  the  so-called  "hyposphyxia"  of 
Martinet.  This  is  a  condition  of  the  circulatory  semi-as- 
phyxia with  venous  stasis,  insufficient  arteriolar  circulation 
with  cold  extremities  and  occasional  slight  blueness  (often 
a  mottled  appearance)  of  the  skin  on  different  parts  of  the 
body,  especially  the  exposed  parts.  In  such  individuals  the 
blood  pressure  is  usually  very  low,  90-100  mm.,  although 
it  has  been  shown  that  extreme  degrees  of  tension  may 
cause  a  functional  insufficiency  of  the  adrenals  by  localized 
hemorrhage  into  the  glands. 

Urticaria  and  other  severe  vasomotor  skin  symptoms  are 
among  the  well  marked  findings  in  persistent  hyposphyxia, 
while  lesser  degrees  may  cause  flushings  and  sensations  of 
passing  distress  localized  in  various  areas  of  the  skin.  The 
adrenal  origin  of  some  forms  of  urticaria  is  seemingly  con- 
firmed by  the  occasional  "miraculous"  disappearance  of 
large  and  most  uncomfortable  wheals  following  a  single 


*  The  subject  of  hypoadrenia  is  so  large  and  the  literature  so  exten- 
sive that  an  entire  issue  (Jan.  1922)  of  Harrower's  Monographs  on 
the  Internal  Secretions  is  devoted  to  the  study  of  "The  Adrenals  in 
Everyday  Medicine."  (120  pages;  sewed;  $1.50  prepaid.  Annual  sub- 
scription $3.00.) 


THE  ADRENAL  GLANDS  117 

hypodermic  injection  of  from  5  to  10  minims  of  adrenalin 
solution. 

Besides  the  circulatory  syndrome  the  muscular  and 
nervous  manifestations  are  important.  Asthenia  is  the  rule 
and  muscular  tone  (both  striped  and  unstriped  muscle)  is 
poor.  Exertion  is  impossible  and  "the  fatigue  syndrome" 
is  prominent.  The  intestinal  musculature  is  inactive  and 
stasis,  a  common  cause  of  hypoadrenia,  is  also  a  usual 
result  of  it.  According  to  Tom  Williams,  mental  exertion, 
even  the  simplest,  often  causes  so  much  weariness  and  ex- 
haustion as  to  be  prohibitive.  Mental  elasticity  is  lost  and 
there  is  both  mental  and  physical  depression  with  the  fear 
that  the  individuals  cannot  now  accomplish  their  accus- 
tomed good  mental  work ;  and  the  story  that  they  "have  lost 
their  nerve."  With  this,  one  frequently  notes  a  fearfulness 
of  making  wrong  decisions  and  a  vacillating  and  indecisive 
frame  of  mind.  This  is  the  most  usual  form  of  adrenal 
insufficiency.  It  is  chronic  both  in  origin  and  in  its  course. 
The  greatest  single  cause  is  chronic  toxemia  either  of  ali- 
mentary or  focal  infective  origin.  Fortunately  the  control 
of  the  cause  and  suitable  "adrenal  support"  (see  Sec.  V, 
Ch.  1)  is  followed  by  very  encouraging  results. 

(2)  Progressive   Hypoadrenia. — Here  we   expect  more 
than  the  mere  functional  derangement  just  discussed.    This 
is  really  another  name  for  the  disease  we  have  been  taught 
was  first  named  by  Addison  in  1855  which,  like  all  organic 
diseases,  may  be  seen  in  differing  forms  and  stages.    The 
main  symptom  is  the  aggravated  asthenia  with  marked 
myasthenia.     In  well  advanced  cases  there  is  a  localized 
bronzing  of  the  skin  and  mucous  membranes  due  to  the 
deposition  of  a  dark  pigment  of  undecided  origin.    Extreme 
cardio-vascular  debility  is  the  rule  and  the  blood  pressure 
may  be  as  low  as  30  to  50  mm.  Hg.    Varying  gastrointes- 
tinal disturbances  are  usual.    Happily,  this  disease  is  rare, 
as  unfortunately  its  outcome  is  hopeless,  though  temporary 
relief  has  followed  adrenal  medication. 

Lawrence  connects  hypofunction  of  the  adrenal  glands 
with  weakness  and  apathy,  marked  fatigability  and  a  ten- 
dency toward  vertigo.  These  are  merely  variations  in  de- 
gree of  the  classical  symptoms  first  reported  by  Addison. 

(3)  Terminal  Hypoadrenia. — This  is  the  extreme  func- 
tional adrenal  insufficiency  which  has  already  been  briefly 
mentioned.    It  occurs  in  the  final  stages  of  fatal  infectious 
diseases.    For  instance,  the  principal  clinical  manifestations 
of  Asiatic  cholera  (the  algid  stage)  are  adrenal  in  origin 


118  PRACTICAL  ORGANOTHERAPY 

and,  remarkably  enough,  have  been  promptly  and  success- 
fully controlled  by  heroic  doses  of  adrenalin,  for  in  such 
cases  the  tolerance  to  the  drug  is  apparently  greatly  in- 
creased and  as  much  as  an  ounce  of  the  commercial  1:1000 
solution  well  diluted  with  saline  solution  has  been  given 
intravenously  during  a  single  day  with  splendid  results 
(Naame). 

Shock,  collapse,  cardiac  failure  and  distressing  asthenia 
are  terminal  findings  in  this  class  of  cases.  Distressing 
meteorism  is  present  and  is  presumably  due  to  functional 
intestinal  paresis  which,  by  the  way,  can  be  experimentally 
produced  by  fright  or  toxemia  and  the  resulting  acute  hy- 
poadrenia. With  these  dread  symptoms  there  is  often  found 
a  noticeable  reduction  in  the  reaction  of  the  organism  to 
urgently  needed  medication,  for  with  the  adrenal  activi- 
ties suspended,  the  responsiveness  of  the  body  to  stimuli  of 
this  character  is  practically  nil. 

The  ominous  sign  of  a  suddenly  reduced  temperature  is 
often  seen  and  is  due  to  the  same  cause.  In  such  cases  one 
can  invariably  produce  Sergent's  "linge  blanche  surrenale" 
a  dermographic  sign  consisting  of  a  white  line  upon  the 
skin  which  follows  penciling  the  abdomen  with  the  fin- 
ger nail,  and  sometimes  lasts  for  two  or  three  minutes. 
This  valuable  clinical  sign  is  said  to  be  pathognomonic  of 
acute  hypoadrenia  and  is  very  easily  elicited. 

In  cases  of  the  character  just  considered,  despite  the 
severity,  the  therapeutic  test  is  often  both  encouraging  and 
confirmatory,  for  the  response  to  hypodermic  or  intravenous 
injections  of  adrenalin  solution  and,  in  many  cases,  the 
early  administration  of  this  remedy  by  mouth,  is  many 
times  nothing  short  of  marvelous.  At  times  I  feel  that  this 
phase  of  adrenal  medication  deserves  to  be  classed  with 
thyroid  in  myxedema  and  with  quinin  in  malaria.  At  least 
it  is  worth  recommending  both  as  a  prophylactic  of  such 
likely  ultimate  results,  and  also  as  a  last  resort  in  their 
treatment. 

Neurasthenia  as  an  Adrenal  Syndrome.*  The  minor  form 
of  functional  hypoadrenia  is  more  common  than  some  have 
appreciated,  and  the  fact  that  there  is  a  psychic  origin  as 
well  as  the  other  physiologic  causes  already  considered, 
allies  it  to  the  fashionable  neurasthenia  of  today.  In  fact, 


*  The  second  (April  1921)  issue  of  Harrower's  Monographs  on  the 
Internal  Secretions  is  entitled  "Neurasthenia:  An  Endocrine  Syn- 
drome," and  takes  up  all  of  the  various  aspects  of  the  subject.  (92 
pages;  sewed;  $1.25  prepaid.  Annual  subscription,  $3.00.) 


THE  ADRENAL  GLANDS  119 

some  have  stated  that  what  is  improperly  called  "neuras- 
thenia" is  not  a  disease  per  se,  but  really  a  symptom  com- 
plex of  ductless  glandular  origin  and  that  the  adrenals  are 
probably  the  most  important  factors  in  its  causation.  Camp- 
bell Smith,  Osborne,  Williams  and  others,  including  the 
writer,  have  directed  attention  to  the  importance  of  the 
adrenal  origin  of  neurasthenia  (though  a  pluriglandular 
dyscrasia  is  practically  always  discoverable) ,  but  so  far  this 
is  not  understood  as  well  as  its  frequency  and  importance 
warrant. 

A  few  quotations  from  the  literature  will  firmly  estab- 
lish the  importance  of  this  angle  from  which  to  study  this 
common  and  annoying  symptom  complex.  Quoting  from 
the  Journal  A.  M.  A.  (Dec.  18,  1915)  :  "The  typical  neurotic 
generally  has,  if  not  always,  disturbance  of  the  thyroid 
gland.  The  typical  neurasthenic  probably  generally  has 
disturbance  of  the  suprarenal  glands  on  the  side  of  insuffi- 
ciency. The  blood  pressure  in  these  neurasthenic  patients 
is  almost  always  low  for  the  individuals  and  their  circula- 
tion is  poor.  A  vaso-motor  paralysis,  often  present,  allows 
chillings,  flushings,  cold  or  burning  hands  and  feet,  drowsi- 
ness when  the  patient  is  up,  wakefulness  on  lying  down  and 
hence  insomnia.  There  may  be  more  or  less  tingling  or 
numbness  of  the  extremities." 

Again,  Kinnier  Wilson  in  his  monographs  on  "The  Clinical 
Importance  of  the  Sympathetic  Nervous  System"  makes 
the  following  pertinent  remarks:  "Many  of  the  common 
symptoms  of  neurasthenia  and  hysteria  are  patently  of 
sympathetic  origin.  Who  of  us  has  not  seen  the  typical 
irregular  blotches  appear  on  the  skin  of  the  neck  and  face  as 
the  neurasthenic  subject  'works  himself  up  into  a  state'? 
The  clammy  hand,  flushed  or  pallid  features,  dilated  pupils, 
the  innumerable  paresthesias,  the  unwonted  sensations  in 
head  or  body,  are  surely  of  sympathetic  parentage.  In  not 
a  few  cases  of  neurasthenia  symptoms  of  this  class  are  the 
chief  or  only  manifestations  of  the  disease.  Here,  then,  is 
a  condition  of  defective  sympatheticotonus ;  may  it  not  have 
been  caused  by  impairment  of  function  of  the  chromophil 
system?  .  .  .  There  does  not  appear  to  me  any  tenable 
distinction  between  the  asthenia  of  Addison's  disease  and 
the  asthenia  of  neurasthenia.  Cases  of  the  former  are  not 
infrequently  diagnosed  as  ordinary  neurasthenia  at  first. 
It  is  difficult  to  avoid  the  conclusion  that  defect  of  glandular 
function  is  responsible  for  much  of  the  clinical  picture  of 
neurasthenia." 


120  PRACTICAL  ORGANOTHERAPY 

Later  this  same  author  makes  the  following  apothegm: 
"Sympathetic  tone  is  dependent  on  adrenal  support,  and 
until  the  glandular  equilibrium  is  once  more  attained  sym- 
pathetic symptoms  are  likely  to  occur." 


SECTION  IV.     CHAPTER  6 
THE  DISORDERS  OF  THE  PITUITARY  BODY 


The  study  of  the  various  phases  of  endocrinology  seems 
to  have  advanced  in  waves ;  and  our  knowledge  of  the  clini- 
cal and  physiological  relations  of  the  hypophysis  or  pituitary 
pody  is  a  good  example  of  this.  Thirty  years  ago  quite  an 
interest  was  aroused  in  this  remarkable  gland  by  the  publi- 
cation of  Marie's  classical  study  of  the  pathology  of  acro- 
megaly  and  his  correlation  with  it  of  disease  of  the  pituitary 
gland.  Nearly  ten  years  later — in  1894— a  greater  wave  of 
enthusiasm  and  interest  was  launched  by  Sir  Edward  A. 
Schaefer  who  made  the  discovery  that  the  pituitary  was  a 
gland  of  internal  secretion.  Numerous  investigations  were 
initiated  by  this  report,  many  of  which  have  added  mater- 
ially to  our  knowledge  of  this  subject. 

The  third  greatest  wave  of  all  must  be  connected  with 
the  name  of  Harvey  Gushing,  and  this  has  brought  us  to 
the  present  high  tide  of  knowledge  of  the  subject,  for, 
thanks  to  the  results  of  the  years  which  Gushing  has  spent 
in  investigating  pituitary  disorders,  the  profession  is  better 
able  to  realize  the  comparative  frequency  of  affections  of 
this  gland. 

Cushing's  monograph,  "The  Pituitary  Body  and  Its  Dis- 
orders," has  been  called  the  most  complete  and  useful  mono- 
graph in  English ;  and  the  numerous  publications  of  reports 
of  his  work  and  that  of  his  associates  include  the  major 
part  of  our  present  knowledge  on  this  subject. 

Physiological  Considerations.  An  appreciation  of  the 
essentials  of  the  physiology  of  this  gland,  its  interrelation 
with  the  other  endocrine  organs,  and  its  influence  upon  the 
activities  of  the  body,  will  enable  us  to  detect  the  several 
results  of  functional  pituitary  dyscrasia  during  their  early 
stages,  before  such  obvious  and  serious  changes  as  those 
present  in  acromegaly  have  established  themselves. 

It  must  be  recalled  that  structurally  the  pituitary  gland 
is  divided  in  three  parts:  the  largest  anterior  lobe  being 


PITUITARY  DISORDERS  121 

a  typical  glandular  structure;  the  much  smaller  posterior 
lobe  having  the  histological  appearance  of  nervous  tissue, 
while  the  very  small  connecting  portion,  usually  called  by 
its  Latin  name  "pars  intermedia,"  is  made  up  of  a  mixture 
of  both  kinds  of  these  cells.  Each  of  these  portions  pro- 
duces one  or  more  chemical  substances  or  hormones,  the 
functions  of  which  are  not  fully  understood.  Without  going 
into  detail,  it  may  be  stated  that  the  anterior  lobe  produces 
a  hormone  which  regulates  the  growth  of  the  body.  This 
was  isolated  recently  by  T.  Brailsford  Robertson  at  the 
University  of  California,  and  has  been  called  by  him 
"tethelin."  In  both  physiology  and  organotherapy  this  sub- 
stance promotes  growth,  especially  that  of  bone  and  con- 
nective tissue ;  and  it  is  expected  that  many  useful  advances 
in  organotherapy  will  follow  the  clinical-experimental  study 
of  preparations  of  the  anterior  lobe  of  the  pituitary. 

From  the  posterior  lobe  there  is  secreted,  presumably 
directly  into  the  cerebro-spinal  canal,  a  series  of  hormones 
which  play  an  important  part  in  the  control  of  metabolism, 
especially  that  of  the  carbohydrates.  They  also  influence 
in  some  subtle  way  the  sympathetic  nervous  system  quite 
similarly  to  the  chromaffin  hormone  from  the  adrenals. 
Much  clinical  use  has  been  made  of  the  extract  of  the  pos- 
terior lobe,  and  undoubtedly  it  exerts  a  very  wonderful 
pharmacological  influence  upon  unstriped  muscle  and  par- 
ticularly upon  the  uterus  in  labor.  A  diuretic  hormone  of 
considerable  activity  is  also  produced  in  this  gland,  some 
saying  that  it  arises  in  the  pars  intermedia  and  others  in 
the  posterior  lobe. 

The  pituitary  lobe  as  a  whole  is  very  intimately  connected 
with  sex  development  as  we  shall  shortly  see ;  and  is  able  to 
assist  the  thyroid  and  gonads  vicariously  when  this  be- 
comes necessary.  These  complex  relationships  complicate 
the  study  of  the  subject,  and  it  might  just  as  well  be  stated 
right  here  that  it  is  not  a  simple  task  accurately  to  differ- 
entiate between  the  results  of  deficiencies  of  these  endocrine 
glands,  for  their  relations  are  so  intimate  that  it  is  quite 
impossible  for  one  to  be  affected  without  some  chemical 
reflex  influence  being  brought  about  in  the  work  of  most  or 
all  of  the  others ;  and  as  these  glands  seem  to  exert  a  com- 
pensatory influence  upon  the  work  of  those  glands  with 
which  they  are  correlated,  it  is  often  difficult  to  determine 
the  original  gland  at  fault  in  a  given  case,  and  unless  this 
is  done,  suitable  treatment,  organotherapeutic  or  otherwise, 
may  be  impossible. 


122  PRACTICAL  ORGANOTHERAPY 

We  have  just  noted  that  there  is  a  great  functional  dif- 
ference between  the  parts  of  the  pituitary.  Like  several 
other  endocrine  organs  it  is  a  dual  one,  with  differing  struc- 
ture and  physiological  powers ;  and  it  is  possible  that  clinical 
manifestations  due  to  affections  of  one  lobe  may  differ  very 
materially  from  those  due  to  disturbance  of  the  other.  An 
attempt  to  facilitate  a  differentiation  between  the  disorders 
of  the  two  lobes  will  follow  the  consideration  of  disease  of 
the  whole  gland. 

Dyspituitarism.  When  disorders  of  the  pituitary  gland 
are  the  result  of  tumors,  cysts  or  intracellular  disturbance, 
there  may  be  varying  secretory  changes.  On  the  one  hand, 
pressure  due  to  the  growth  may  prevent  the  normal  secre- 
tory activity,  while,  on  the  other  hand,  the  enlargement 
may  be  a  pure  hyperplasia  with  markedly  increased  func- 
tion until  the  limitations  of  the  sella  turcica — the  bony  cup 
above  the  sphenoid  bone  in  which  the  pituitary  rests — cause 
a  secondary  hypofunction.  Such  cases  are  termed  dyspitui- 
tarism, since  varying  results  are  produced.  In  fact,  many 
individuals  suffering  from  pituitary  excess,  have  at  the 
same  time  evidences  of  pituitary  insufficiency,  secondary 
to  the  original  trouble. 

Dyspituitarism,  then,  is  pituitary  secretory  dyscrasia  and 
may  include  the  pure  hypo-  and  hyper-function  and  all 
grades  between  them  and  combinations  of  them.  By  care- 
ful study  it  is  often  possible  to  decide  which  disturbance  is 
predominant  and  also  which  is  the  original  disorder.  A 
diagnosis  of  "dyspituitarism"  is  good;  but  to  qualify  this 
and  go  further  into  the  genesis  of  the  disorder,  is  much 
better. 

Pituitary  Insufficiency.  With  the  fundamentals  previously 
outlined  in  mind,  we  can  expect  marked  changes  in  the 
metabolism  as  a  result  of  insufficient  activity  of  the  pitui- 
tary gland.  The  most  common  result  of  insufficient  function 
— hypopituitarism — is  an  undue  increase  in  the  deposit  of 
fat  which  later  may  become  a  serious  obesity,  a  condition 
which  is  probably  due  to  the  marked  increase  in  the  toler- 
ance for  carbohydrates  usually  found  in  hypopituitarism, 
and  the  abnormal  desire  for  food  and  especially  for  sweets 
with  which  this  is  quite  often  associated.  It  is  not  uncom- 
mon to  find  patients  in  this  class  eating  ravenously  with 
appetites  far  beyond  the  usual. 

The  cellular  activities  are  generally  reduced  and  the  tem- 
perature is  subnormal,  movements  slow  and  somnolence  is 
a  prominent  symptom.  Parenthetically,  Gushing  and  his 


PITUITARY  DISORDERS  123 

associates  have  remarked  that  hibernation  in  certain  ani- 
mals seems  to  be  a  physiological  hypopituitarism.  Lassi- 
tude, torpidity  and  drowsiness  are  often  the  first  appreci- 
ated symptoms.  (Some  years  ago  I  saw  a  case  with  Dr.  W. 
W.  Roblee  at  Riverside,  who  would  fall  asleep  during  meals 
or  in  the  middle  of  a  sentence;  and  who,  by  the  way,  im- 
proved very  much  under  pituitary  medication.)  Sleep  is 
not  always  refreshing  and  tiredness  is  a  usual  complaint. 

This  reduced  oxidation  is  probably  due  in  part  to  an  asso- 
ciated thyroid  insufficiency.  The  urinary  solids  are  reduced, 
but  the  amount  of  urine  is  often  increased;  and  it  is  now 
believed  that  the  majority  of  those  suffering  from  extreme 
polyuria,  or  diabetes  insipidus,  really  have  a  form  of  pitui- 
tary disease.  According  to  Motzfeldt  and  others,  the  lesion 
is  in  the  posterior  lobe,  and  the  functional  changes  are  on 
the  side  of  hyposecretion. 

There  are  well  defined  and  almost  pathognomonic  retro- 
gressive changes  in  the  sex  organs  and  functions.  The 
syndrome  described  by  Frohlich  and  Bartels — the  so-called 
"dystrophia  adiposo-genitalis" — is  due  to  hypopituitarism, 
the  adiposity  being  marked  and  the  sex-changes  charac- 
teristic. 

The  age  at  which  these  conditions  assert  themselves  nat- 
urally causes  variations  in  the  manifestations.  When  pitui- 
tary insufficiency  is  present  in  childhood  or  early  youth,  the 
developmental  changes  are  more  marked.  The  stature  is 
small  and  skeletal  growth  is  stunted.  Genu  valgum  is 
quite  common.  The  fingers  are  frequently  tapered  and 
considerably  shortened,  with  a  stubby  appearance.  Acro- 
micria,  i.  e.,  unusually  small  hands  and  feet,  has  been  noted 
by  Timme,  though  this  is  rare  compared  with  the  corre- 
sponding opposite  (acromegaly)  in  the  opposite  condition. 
The  epiphyses  may  remain  ununited  and  it  is  well  in  cases 
of  reduced  stature  to  have  Roentgen  pictures  made  of  a 
hand,  so  that  if  defective  epiphyseal  growth  is  still  present, 
there  is  hope  for  comparatively  successful  results  from  suit- 
able organotherapy.  On  the  other  hand,  in  dwarfs  showing 
fully  united  epiphyses  there  is  little  hope  that  the  most  effec- 
tive therapeutic  measures  will  increase  the  stature. 

Temperamentallly,  children  with  hypopituitarism  are  dull, 
apathetic,  backward  in  their  studies  and  easily  discouraged. 
They  often  have  difficulties  with  their  playmates  and  lack 
both  self-reliance  and  self-control. 

The  abnormalities  of  sex  development  are  among  the  most 
typical  results  of  pituitary  insufficiency.  The  external  geni- 


124  PRACTICAL  ORGANOTHERAPY 

tals  are  small,  the  pubertial  growth  of  hair  is  sparse  or  ab- 
sent. There  may  be  either  cryptorchidism  or  infantile  uterus 
with  impotence  or  amenorrhea.  The  menses  appear  late 
or  not  at  all,  and  if  the  amenorrhea  is  not  complete,  the 
flow  is  scanty  and  irregular.  The  breasts  often  become 
extremely  large  due  both  to  the  adiposity  usually  present 
and  to  the  reduced  gonad  activity.  A  peculiar  and  quite  con- 
stant finding  is  a  tendency  to  development  which  simulates 
that  of  the  opposite  sex,  especially  in  the  male,  in  whom 
the  pubic  hair  line  is  straight  and  the  contour  of  the  hips 
and  chest  quite  female  in  type. 

The  head  is  often  small  and  the  face  unintelligent,  and 
the  distance  between  the  eyes  narrowed.  The  teeth  are 
usually  malformed  and  broad.  The  skin  is  dry  and  soft,  and, 
compared  with  the  dry,  rough  skin  of  hypothyroidism,  is 
quite  smooth  to  the  touch,  and  wrinkling  of  the  skin, 
especially  on  the  backs  of  the  hands,  with  deep  cutaneous 
furrows  surrounding  each  digit,  is  mentioned  as  a  charac- 
teristic feature  by  Boston.  Perspiration  is  much  reduced, 
even  in  hot  weather  and  during  exertion. 

When  hypopituitarism  is  acquired  after  maturity  it  is 
often  the  result  of  syphilis,  and  the  developmental  changes 
just  enumerated  are  not  present.  Here,  however,  there  is 
anaphrodisia  and  sexual  atrophy,  obesity  which  may  be  ex- 
treme, with  difficulty  in  locomotion  and  work,  with  a  natural 
tendency  to  laziness  and  lethargy  which  further  increase 
the  asthenia  and  deposition  of  fat.  Occasionally  the  fatty 
deposits  are  painful  on  pressure  and  are  very  similar  to 
Dercum's  disease  or  adiposis  dolorosa,  a  condition  which  is 
probably  of  both  pituitary  and  thyroid  origin.  This  adi- 
posity causes  difficulties  with  the  heart  and  breathing  and 
edema  may  supervene  due  to  fatty  pericardial  involvement. 

Asthenia  is  the  rule,  irrespective  of  the  extent  of  the 
obesity,  and  the  unstriped  muscles  seem  to  be  affected 
equally  with  the  voluntary  muscles,  hence  constipation  is 
common  and  the  bladder  walls  may  be  unduly  weak  with 
incontinence.  The  heart  action  is  weak  and  the  pulse  slow 
and  of  reduced  volume.  The  blood  pressure  is  low,  ranging 
from  100  mm.  Hg.  to  as  low  as  50  mm.  or  less.  The  circu- 
lation is  poor,  the  extremities  are  cold  and  sometimes  ede- 
matous  late  in  the  day,  and  occasionally  the  skin  exhibits 
the  mottled  appearance  referred  to  in  the  previous  chapter. 
Several  authorities  have  noticed  epilepsy  as  an  accom- 
paniment of  hypopituitarism.  Just  what  is  the  relation- 
ship we  have  yet  to  learn,  but  several  writers,  including 


PITUITARY  DISORDERS  125 

Gushing  and  Engelbach,  have  remarked  that  pituitary  feed- 
ing caused  a  decided  benefit  to  the  epileptic  manifestations 
as  well  as  those  which  are  more  generally  recognized  as  of 
pituitary  origin.  The  therapeutic  side  of  "endocrine  epi- 
lepsy" is  an  important  and  seemingly  hopeful  subject  and  is 
considered  further  in  Chapter  2  of  the  following  section. 

Hyperpituitarism.  The  start  toward  our  present  knowl- 
edge of  the  conditions  associated  with  pituitary  excess  (hy- 
pertrophy and  secretory  activity)  was  made  in  the  report 
of  several  cases  in  1886  by  Pierre  Marie.  He  called  the 
syndrome  "acromegalia"  because  of  the  usually  large  hands 
and  feet  which  were  a  prominent  part  of  the  clinical  syn- 
drome. A  comparison  of  the  manifestations  of  increased 
pituitary  secretion  would  be  expected  to  show  diametrically 
opposite  findings  to  many  of  the  hypopituitaric  conditions 
above.  For  example,  children  with  hyperpituitarism  are 
large  for  their  age,  tall  and  bony  framed.  Their  eyes  are 
wide  apart,  the  face  is  broad,  the  cheeks  prominent  and  the 
jaw  square  and  large.  The  condition  of  the  facial  bones  is 
generally  called  prognathism.  The  teeth  many  times  are 
large,  broad  and  irregularly  spaced. 

Such  individuals  have  large  hands  and  feet,  with  long 
fingers  and  toes  and  an  unusually  early  epiphyseal  union. 
The  hair  is  usually  profuse,  exhibits  a  tendency  to  grow 
low  on  the  forehead,  well  up  on  the  abdomen  and,  occasion- 
ally, hypertrichosis  is  present.  The  axillary  and  pubic 
hair  comes  unusually  early  and  is  always  excessive.  The 
skin  is  thick,  harsh  and  sometimes  puffy.  The  sweat  glands 
are  usually  active. 

The  sexual  development  is  excessive  and  in  early  cases 
precocity  is  to  be  expected  and  sexual  irritability  may  be 
marked.  The  sympathetic  system  is  well  developed  and 
highly  sensitive.  Hyperpituitaric  individuals  are  often 
bright  and  keen  and  very  excitable,  though  they  lack  the 
power  of  concentration  and  are  indecisive.  Temperamentally, 
they  are  often  irritable,  distrustful,  petulant  and  "difficult." 
They  do  not  sleep  well  and  insomnia  is  progressive  as  the 
glandular  hypertrophy  causes  the  local  symptoms  which 
will  be  referred  to  shortly. 

The  metabolism  is  plus  and  much  accumulation  of  fat  is 
rare.  There  may  be  a  slight  increase  in  the  temperature, 
and  the  urinary  solids  are  often  increased.  The  tolerance 
to  carbohydrates  is  reduced  and  the  "carbohydrate  tolerance 
test"  is  positive  with  25  or  50  grams  of  sugar  and  not  infre- 
quently glycosuria  is  a  symptom  of  hypopituitarism. 


126  PRACTICAL  ORGANOTHERAPY 

A  urinary  test  for  dyspituitarism  is  thus  made  possible. 
The  high  tolerance  for  sugar  is  usual  in  hypopituitarism. 
This  may  be  easily  demonstrated  by  giving  measured,  in- 
creasing amounts  of  sugar  or,  preferably,  levulose,  and 
noting  how  much  may  be  taken  without  glycosuria.  Often 
as  much  as  250  grams  can  be  eaten  (Gushing  reports  a  case 
in  which  450  grams  was  taken)  without  a  trace  of  glucose 
in  the  urine  passed  during  the  next  few  hours  thereafter. 
On  the  other  hand,  in  the  opposite  secretory  condition— 
hyperpituitarism — there  is  a  very  low  sugar  tolerance,  and 
not  infrequently  there  may  be  glycosuria. 

The  pulse  rate  is  occasionally  increased,  though  not  very 
rapid;  but  the  blood  pressure  may  be  high,  ranging  from 
150  to  180  mm.  or  more. 

Both  gigantism  and  acromegaly  are  the  result  of  hyper- 
pituitarism; but  in  the  former  instance  the  dystrophy  has 
commenced  before  ossification  of  the  bones  has  taken  place 
with  a  resultant  increase  in  length  principally.  In  acrome- 
galy, i.  e.,  hyperpituitarism  after  full  development,  the  bone 
changes  tend  to  thickness,  hence  the  prognathism,  protrud- 
ing forehead  and  "heavy"  facies,  and  the  kyphotic  spine  not 
uncommonly  seen. 

Neighborhood  Symptoms.  When  the  secretory  disturb- 
ances of  the  pituitary  are  coupled  with  hypertrophic 
changes,  a  series  of  localized  symptoms  is  caused  which 
are  of  a  wholly  distinct  character  from  those  due  to  chemi- 
cal changes — the  pressure  or  neighborhood  symptoms. 
These  are  ultimate  results  and  are  practically  always  accom- 
panied by  changes  in  the  size  and  conformation  of  the  sella 
turcica  which  can  be  seen  and  even  measured  by  roentgen- 
ography. 

Unfortunately  these  pressure  symptoms  are  often  the  first 
indication  that  we  have  dyspituitarism  to  contend  with,  and 
they  are  practically  seen  only  in  advanced  cases.  Under 
such  circumstances  we  can  expect  to  find  supplementary 
evidence  of  the  cause  of  the  trouble  by  looking  for  the  sys- 
temic chemical  changes  of  pituitary  origin  which  have 
already  been  enumerated.  These  localized  symptoms  are 
often  so  serious  as  to  call  for  cerebral  decompression  and 
curative  treatment  is  practically  hopeless :  while  the  general 
metabolic  disturbances  previously  mentioned  often  may  be 
favorably  affected  by  persistent  organotherapy. 

To  quote  a  statement  from  Gushing:  "It  is  particularly 
important  that  we  should  learn  to  recognize  these  clinical 
expressions  of  hypophyseal  disorder  in  the  absence  of  brain 


PITUITARY  DISORDERS  127 

tumor  symptoms  or  radioscopic  enlargement  of  the  pituitary 
fossa,  in  the  same  way  that  it  is  important  for  us  to  recog- 
nize thyroid  disorders  unaccompanied  by  gross  evidence  of 
change  in  the  configuration  of  the  gland." 

Neighborhood  symptoms  may  be  roughly  divided  into  two 
classes:  Immediate  (local)  and  intracranial  (general)  pres- 
sure effects.  In  the  former  we  look  for  the  results  of  pres- 
sure on  the  structures  in  contact  with  the  mass ;  while  in  the 
latter,  those  found  in  any  brain  tumor — due  to  the  increased 
intracranial  pressure. 

Among  the  former  symptoms  are  well  marked  eye  symp- 
toms such  as  bitemporal  hemianopsia  (blindness  of  the  outer 
temporal  fields  of  vision)  due  to  pressure  on  the  optic  chias- 
ma.  This  usually  first  affects  color  only  and  later  form.  In 
more  advanced  cases,  when  the  tumor  extends  beyond  the 
sellar  edges,  squint  results,  due  either  to  pressure  on  the 
sixth  cranial  nerve  (internal  strabismus)  or  the  third  cra- 
nial nerve  (external  strabismus).  As  a  result  of  still  more 
extensive  involvement,  there  may  be  pressure  on  the  crura 
cerebri  and  disturbances  of  gait  with  a  positive  Babinski 
sign.  Certain  epileptoid  attacks,  the  so-called  "uncinate  fits" 
are  occasionally  seen  and  are  probably  due  to  pressure  upon 
the  uncinate  gyrus.  The  relationship  of  epilepsy  and  pitui- 
tary disease  is  interesting  and  bids  fair  to  offer  a  part  of  the 
solution  of  this  problem. 

Before  the  last  of  these  pressure  symptoms  have  been 
caused,  general  intracranial  symptoms  will  have  supervened. 
These  consist  chiefly  of  a  severe  intractable  headache,  par- 
oxysmal in  character  and  often  affecting  both  temples,  with 
vertigo,  vomiting  (often  of  the  projectile  type)  and  failing 
vision  with  later  choked  disc  (papilloedema)  and  progres- 
sive destruction  of  the  visual  fields  and  ultimate  optic 
atrophy. 

Differentiating  the  Lobes  Involved.  It  is  rare  that  we  find 
dyspituitarism  of  a  single  lobe,  though  it  is  possible.  It  is 
not  unusual,  however,  to  find  predominating  symptoms  indi- 
cating that  the  principal  trouble  is  in  one  of  the  lobes.  If 
we  bear  in  mind  the  varying  physiological  activities  of  the 
different  portions  of  the  hypophysis  we  will  expect  to  find 
anterior  lobe  disorders  more  frequently  accompanied  by 
changes  in  growth  and  skeletal  development.  We  have  seen 
that  with  hypersecretion  early  the  result  is  giantism, 
whereas  later  in  life,  acromegaly  is  the  result.  On  the  other 
hand,  hyposecretion  retards  the  growth  and  if  it  comes 
early  the  result  is  infantilism,  while  later  it  brings  about 


128  PRACTICAL  ORGANOTHERAPY 

retrogressive  changes  in  the  sex  organs  and  manifestations. 

Dystrophies  of  posterior  lobe  origin  are  quite  different, 
since  they  account  for  metabolic  changes  which  cause  the 
adiposity  and  increased  carbohydrate  tolerance  found  in 
hypopituitarism,  while  the  excessive  secretory  activity  of 
the  posterior  lobe  produces  a  relative  carbohydrate  intoler- 
ance with  glycosuria  and  increased  metabolism  and  loss  of 
weight. 

Commonly  both  lobes  are  affected  simultaneously,  though 
the  effects  of  one  lobe  may  be  more  prominent  and  may 
change  at  different  stages  of  the  disease.  Frohlich's  syn- 
drome, for  instance,  is  evidently  due  to  a  secretory  deficiency 
of  the  whole  gland. 

The  Cause  of  Pituitary  Affections.  Etiology  is  often  of 
great  service  in  making  a  therapeutically  useful  diagnosis. 
In  the  estimation  of  the  writer  syphilis  is  the  chief  cause  of 
dyspituitarism,  and  while  heredity  is  an  evident  factor, 
syphilis  in  parents  and  grandparents  may  have  left  an  in- 
tangible susceptibility.  The  Wassermann  test  is  very  use- 
ful here. 

New  growths  of  the  hypophysis,  other  than  gummata, 
are  common  etiological  factors,  the  causes  of  which  are  still 
altogether  unknown.  Early  organic  changes  in  the  bony 
pituitary  fossa  may  restrict  the  proper  development  of  the 
growing  gland.  Brain  tumors,  either  adjacent  to  the  pitui- 
tary or  remote  from  it,  may  cause  dyspituitarism  by  increas- 
ing the  intracranial  pressure  and  the  pituitary  symptoms 
may  entirely  disappear  following  decompression. 

It  has  also  been  suggested  that  as  the  posterior  lobe  is 
supposed  to  secrete  into  the  cerebro-spinal  canal,  changes 
in  the  intraspinal  pressure  may  cause  pituitary  disorder. 


SECTION  IV.    CHAPTER  7 
ENDOCRINE  DYSFUNCTION  OF  THE  MALE  GONADS 


"Removal  of  tne  sexual  glands  produces  profound  changes 
in  the  organism,  evidenced  as  alterations  of  bodily  physique 
and  of  temperament.  If  the  extirpation  is  made  at  an  early 
period  in  life,  the  so-called  secondary  sexual  characters  may 
fail  to  exhibit  themselves  in  the  usual  manner,  and  thus 
occasion  the  retention  of  infantile  characteristics  in  place 


THE  MALE  GONADS  129 

of  typical  features  of  adult  form  and  behavior.  There  is 
reason  to  believe  that  we  may  properly  speak  of  'genital  hor- 
mones' at  the  present  time,  in  explanation  of  the  undoubted 
chemical  correlation  exerted  by  the  genital  glands  on  other 
parts  of  the  reproductive  apparatus  as  well  as  on  the  or- 
ganism in  general.  At  any  rate,  the  secondary  sexual  char- 
acters must  be  associated  with  the  influence  of  chemical 
substances  produced  by  the  ovary  and  testis,  respectively. 
Castration  after  puberty  cannot  modify  profoundly  the  de- 
velopment of  structures  like  the  skeleton,  which  are  already 
completed;  but  it  may  unquestionably  bring  about  obvious 
structural  and  even  functional  changes  which  can  be  deter- 
mined by  careful  observation." 

The  foregoing  paragraph,  quoted  from  an  editorial  in  the 
Journal  of  the  American  Medical  Association  (May  13, 
1916) ,  is  a  fit  introduction  to  my  brief  consideration  of  this 
subject.  The  "genital  hormones"  from  the  testes,  like  hor- 
mones from  other  glands,  may  be  produced  in  insufficient 
quantities  (hypogonadism)  or  may  be  absent  (agonadism). 
Varied  functional  as  well  as  structural  changes  result.  They 
are  not  very  difficult  to  diagnose;  but  the  establishment  of 
the  cause  is  another  matter. 

Perhaps  the  endocrine  dysfunction  of  the  testes  does  not 
require  a  comprehensive  study,  for  we  are  better  acquainted 
with  the  results  of  increased  or  decreased  physiological  ac- 
tivity of  these  glands.  An  early  hypogonadism  virtually 
means  essential  infantilism,  sexual  insufficiency  and  malde- 
velopment  as  cryptorchidism  and  total  absence  of  the  tes- 
ticles. 

Essential  Infantilism.  There  are  several  clinical  forms 
of  organic  gonad  disorder:  Infantilism  is  the  condition  in 
which  the  glands  are  poorly  developed  or  absent.  Here  the 
results  are  much  the  same  as  in  hypo-ovarism,  the  form  and 
function  are  changed,  the  bodily  growth  is  altered  and  the 
secondary  sexual  characteristics  which  normally  should 
show  themselves  at  puberty  do  not  materialize. 

The  testicles  are  very  small,  the  scrotum  atrophied  and 
the  penis  short  and  incapable  of  erection.  Infantilism  may 
vary  in  degree,  and  developmental  changes  are  not  always 
necessarily  accompanied  by  absolute  inactivity  of  the  inter- 
stitial cells  of  Leydig.  In  this  case,  there  eventually  may 
be  possibilities  of  sexual  desire  and  azoospermia  may  be 
absent.  The  cause  may  be  inherent  in  the  sex  glands  them- 
selves, but  usually  is  due  to  other  endocrine  difficulties  which 
are  discussed  elsewhere. 


130  PRACTICAL  ORGANOTHERAPY 

Cryptorchidism.  The  developmental  anomaly  known  as 
cryptorchidism,  also  known  as  "undescended  testicle,"  is  not 
rare;  but  cases  with  permanent  cryptorchidism  are  very 
uncommon.  There  may  be  two  forms,  the  abdominal  and 
the  inguinal.  Occasionally  this  condition  is  accompanied  by 
testicular  maldevelopment  with  lack  of  all  the  functions  de- 
pendent upon  proper  activity  of  the  Leydig  cells.  Again, 
despite  complete  burial  of  the  testes,  they  may  be  function- 
ally active,  in  which  case  there  is  sterility  in  individuals 
none  the  less  potent,  the  sterility  being  purely  mechanical 
rather  than  functional.  Such  cases  obviously  are  not  sub- 
ject to  the  same  degree  of  asexualism  as  in  pure  infantilism 
or  in  castrates. 

I  have  seen  many  endocrine  dystrophies  of  the  gonads 
which  were  not  essential,  i.  e.,  they  were  related  to  pituitary 
or  thyroid  disturbances  (insufficiency)  and  the  matter  is 
mentioned  in  the  chapters  devoted  to  these  subjects  re- 
spectively. I  recall  a  case  of  a  defective  boy  of  ten  with 
cryptorchidism  to  whom  I  recommended  my  Antero-Pitui- 
tary  Co.  I  explained  to  the  mother  that  I  did  not  believe 
that  there  were  no  testes  at  all  but  that  they  had  not  de- 
scended. I  also  said  that  they  would  not  likely  develop  at 
puberty  if  they  were  permitted  to  remain  in  the  canal  and 
that  surgical  treatment  should  be  given  before  then.  I 
hinted  (ever  so  carefully),  that  the  medical  treatment  (or- 
ganotheraphy)  might  help;  and  to  the  surprise  and  delight 
of  all,  the  testes  both  came  down  after  nine  weeks  of  this 
treatment  with  nothing  added  but  some  simple  dietetic  ad- 
monitions. The  only  sad  thing  about  the  case  was  the  com- 
ment of  a  colleague  that  it  was  "probably  a  coincidence!" 

Eunuchoidism.  The  condition  known  as  eunuchoidism  is 
presumed  to  be  an  acquired  disorder  of  the  interstitial  cells 
of  Leydig,  and  those  with  this  disturbance  are  quite  similar 
in  functional  incapacity  to  a  castrate  but  without  the  ab- 
sence of  the  testes.  Here  there  is  complete  functional  loss 
of  the  sex  principle  later  in  life,  so  that  the  more  marked 
manifestations  of  infantilism  are  not  present. 

The  eunuchoid  is  so  named  from  the  similarity  in  form  to 
the  eunuch  or  castrate,  and  in  addition  to  the  retrogressive 
changes  in  the  secondary  sex  characteristics — avirilism,  re- 
duction of  facial,  axillary  and  pubic  hair,  genital  atrophy, 
etc.,  there  is  an  acquired  corpulency  due  to  the  loss  of  the 
powerful  oxidizing  principle  produced  in  the  interstitial  cells. 
A  subnormal  temperature  is  the  rule  in  these  individuals, 
and  it  has  even  been  suggested  that  this  common  associate 


THE  MALE  GONADS  131 

finding  in  senility  (or  presenility)  is  of  gonad  origin. 

Eunuchoidism  may  be  due  to  disease  or  be  a  spontaneous 
hormonically  produced  disorder,  and  it  is  accompanied  by  a 
loss  of  the  factors  dependent  upon  active  sex-gland  func- 
tion— assertiveness,  courage,  animation  and  sexual  power. 
The  ergograph  has  been  effectively  used  to  demonstrate  the 
actual  loss  of  energy  and  power  following  disease  or  injury 
to  the  gonads,  as  well  as  to  show  the  energizing  influence 
of  suitable  organotherapy  or  the  more  recent  work  by  Lyd- 
ston  and  others,  with  sex  gland  transplantation. 

Functional  Sexual  Disturbances.  Many  a  monograph  has 
been  written  on  this  subject,  and  it  is  far  too  large  to  be 
considered  fully  here.  Impotence,  presenility  and  senile  tes- 
ticular  insufficiency  always  have  been  a  subject  of  perennial 
interest.  From  a  diagnostic  standpoint,  the  principal  symp- 
toms are  lack  of  sexual  desire  and  power  and  "sexual  neuras- 
thenia" with  its  innumerable  manifestations.  According  to 
Williams,  functional  testicular  disorders,  especially  on  the 
side  of  deficiency,  are  known  to  cause  general  depression, 
hysteria,  hypochondria,  melancholia  and  also  digestive  dis- 
turbances. 

It  may  be  well  to  recall  that  the  fundamental  basis  of 
modern  organotherapy  and  the  "fillip"  which  restarted  an 
interest  in  the  age-old  study  of  organ  medication  was  the 
use  by  Brown-Sequard  of  testicular  extract  on  himself.  The 
dynamogenic  influence  of  this  sort  of  treatment  then,  as 
now,  is  unquestioned ;  but  for  various  reasons  it  has  never 
assumed  the  importance  that  it  really  deserves.  It  is  given 
some  consideration  elsewhere  in  the  chapter  entitled,  "The 
Hormones  in  Impotence"  (Sec.  V,  Chap.  21). 

Senility  and  Presenility.  According  to  Lorand,  "A  man 
is  as  old  as  his  internal  secretions,"  and  the  condition  we  call 
"age"  is  nothing  but  a  gradual  waning  in  the  endocrine 
functions  with  the  accompanying  reduced  cellular  activity 
and  unavoidable  toxemia,  which  finally  overburdens  the 
body  and  allows  the  vital  organs  to  fail.  The  condition  we 
call  "senility"  is  merely  old  age,  and  "presenility"  is  a  pre- 
mature aging  which  may  range  from  the  remarkable  con- 
dition known  as  progeria  (infantile  senility)  to  a  prema- 
ture loss  of  virility.  This  capacity,  the  maturity  and 
strength  of  manhood,  is  bound  up  in  the  powers  of  procrea- 
tion; and  when  this  capacity  wanes,  whether  from  age  or 
disease,  senility  exists — or  avirilism.  This  is  accompanied 
by  loss  of  strength,  deficient  oxidation,  malnutrition,  es- 
pecially of  the  skin  and  appendages,  and  resulting  in  wrin- 


132  PRACTICAL  ORGANOTHERAPY 

kles,  old  appearance  and  the  loss  of  hair  and,  above  all,  of 
the  endocrine  and  spermatogenic  functions  of  the  testes. 
This  is  a  natural  consequence  of  the  ravages  of  time,  just 
as  it  is  a  premature  consequence  of  the  ravages  of  lust.  In 
both  instances,  the  essential  sex  glands  are  functionally  in- 
active, and  there  is  present  the  same  hypogonadism  that  we 
find  in  the  pathological  conditions  previously  enumerated. 

The  diagnosis  need  not  be  discussed  further,  and  its  suc- 
cessful control  through  a  mythical  ''Elixir  Vitae"  has  been 
the  goal  of  many  from  time  immemorial  and  from  Ponce 
de  Leon  to  the  present  day.  Hypogonadism  may  be  amen- 
able to  organotherapy,  even  in  elderly  men,  and  the  funda- 
mental principle  of  homostimulation  (see  Sec.  II,  Chap.  2) 
holds  good  "in  proportion  to  the  responsiveness  of  the 
glands  thus  stimulated."  It  is  a  broader  matter  than  the 
gonads  alone,  as  the  thyroid,  pituitary  and  other  endocrine 
glands  all  play  their  part.  Senility,  then,  is  hypocrinism 
rather  than  hypogonadism  alone;  and  if  we  must  treat  it, 
it  should  be  treated  in  the  larger  sense;  and  when  organo- 
therapy is  in  mind  it  should  be  preferably  pluriglandular 
therapy. 

Undoubtedly  there  is  such  a  condition  as  hypergonadism ; 
but  in  most  cases  we  have  to  meet,  the  origin  is  psychic  and 
usually  beyond  the  control  of  ordinary  medical  treatment. 
From  a  diagnostic  standpoint,  it  is  not  difficult  to  deter- 
mine. 


SECTION  IV.     CHAPTER  8 
THE  DIAGNOSIS  OF  OVARIAN  DYSCRINISM 


The  ovaries  produce  at  least  two  distinct  internal  secre- 
tions, one  from  the  corpora  lutea  and  the  other  from  the 
interstitial  cells  or  stroma.  The  differentiation  of  the  hor- 
monic  value  of  these  substances  is  difficult,  but,  broadly 
speaking,  the  luteal  hormone  is  chiefly  concerned  with  the 
determination  and  production  of  menstruation  and  probably 
the  growth  of  the  sex  organs,  while  on  the  other  hand,  the 
stromal  hormone  is  chiefly  concerned  in  the  regulation  of 
the  nutrition  of  the  uterus  and  is  believed  to  exert  an  in- 
hibitory action  upon  the  menses.  Some  believe  that  the 
luteal  hormone  also  sensitizes  the  uterus  to  prepare  it  for 


OVARIAN  DYSCRINISM  133 

pregnancy  and  the  development  of  the  placenta.  It  is  sug- 
gested that  these  two  hormones,  acting  in  alternation,  bring 
about  the  entire  phenomenon  of  menstruation. 

The  biochemical  basis  of  femininity  is  much  more  im- 
portant than  either  the  psychological  basis  or  that  depend- 
ent upon  the  nervous  system.  The  hormones  transcend  in 
importance  all  other  factors  in  the  regulation  of  the  chem- 
istry of  the  body  and,  therefore,  of  the  chemistry  of  the 
reproductive  organs.  Hence,  derangements  in  the  endocrine 
glands,  particularly  the  gonads,  spell  disturbed  metabolism, 
altered  nutrition  and  modified  sex  conditions.  Most  cer- 
tainly the  ovaries  have  much  more  to  do  with  remote  non- 
sexual  factors  than  is  usually  believed ;  and  while  it  may  not 
be  known  to  which  portion  of  the  organ  the  effects  may  be 
credited,  it  is  certain  that  the  ovaries  are  definitely  con- 
cerned in  the  subtleties  of  cellular  chemistry  and  have  much 
to  do  with  the  maintenance  of  the  calcium  balance. 

The  Influence  of  the  Associated  Glands.  The  fact  that  the 
ovarian  internal  secretions  are  so  intimately  connected  with 
those  of  other  glands,  notably  the  thyroid  and  pituitary, 
makes  it  rather  difficult  to  set  down  accurately  the  results 
of  ovarian  dysfunction  since  the  symptoms  may  not  neces- 
sarily be  purely  ovarian  but  rather  due  to  a  pluriglandular 
manifestation  which  includes  factors  not  of  ovarian  origin 
at  all.  For  instance,  according  to  Osborne,  a  woman  cas- 
trated during  menstrual  life  generally  adds  weight,  not  only 
because  of  the  cessation  of  the  loss  of  blood,  but  also  be- 
cause of  the  loss  of  the  ovarian  secretion  and  "of  the  coin- 
cident lessening  of  thyroid  secretion  and  perhaps  of  pitui- 
tary secretion."  The  supreme  importance  of  these  rela- 
tions is  emphasized  in  another  quotation  from  the  same 
authority  (N.  Y.  Med.  Jour.,  Sept.  1918)  :  "The  thyroid  is 
typically  a  female  gland,  entering  constantly  into  the 
woman's  sexual  life.  Menstruation  cannot  possibly  occur 
without  the  activity  of  the  thyroid.  Too  much  thyroid  se- 
cretion may  cause  profuse  or  too  frequent  menstruation. 
The  thyroid  hypersecretes  at  each  menstrual  epoch  and 
during  pregnancy,  and  many  disturbances  of  the  menopause 
are  due  to  too  much  or  too  little  thyroid  secretion.  .  .  . 
All  through  female  life,  the  thyroid  secretion  is  of  constant 
importance,  and  normal  ovarian  and  uterine  functions  can- 
not occur  without  normal  thyroid  function.  In  female  cre- 
tins, the  genital  organs  may  develop,  but  do  not  function." 

Another  phase  of  the  thyro-ovarian  relationship  must  be 
mentioned,  under  the  circumstances.  The  ovarian  secretion 


134  PRACTICAL  ORGANOTHERAPY 

reciprocally  stimulates  the  thyroid,  and  at  the  change  of  life 
the  absence  of  hormone  stimulation  from  the  ovaries  may 
cause  a  thyroid  insufficiency,  with  the  result  that  the  woman 
adds  weight  more  or  less  rapidly,  the  skin  becomes  dry,  she 
may  be  sleepy  and  more  or  less  mentally  apathetic,  and  in 
general  she  shows  the  signs  of  myxedema.  According  to 
Osborne,  "this  (menopause)  is  a  period  of  life  when  myx- 
edema is  most  frequent,  by  far  the  majority  of  all  non-oper- 
ative myxedematous  cases  occuring  in  women  and  in  the 
decade  of  forty  to  fifty."  Hence  it  can  be  seen,  both  from 
the  standpoint  of  cause  as  well  as  of  effect,  that  ovarian 
insufficiency  is  so  definitely  connected  with  the  thyroid 
function  that  the  symptoms  are  really  also  the  symptoms 
of  thyroid  insufficiency,  and  vice  versa. 

From  the  standpoint  of  diagnostic  endocrinology,  the 
ovaries  are  subject  to  three  forms  of  functional  disorder: 
(1)  deficient  secretion,  (2)  excessive  secretion,  and  (3)  per- 
verted secretion.  The  results  of  these,  limited  as  far  as 
possible  to  the  ovaries  and  not  to  pluriglandular  syndromes 
in  which  the  ovaries  play  a  part,  will  be  considered  briefly 
and  the  diagnostic  essentials  outlined  here. 

Symptoms  of  Ovarian  Insufficiency.  The  outstanding  man- 
ifestation of  hypo-ovarism  is  amenorrhea  in  varying  degrees 
from  a  complete  absence  of  the  menses,  through  irregular 
menstruation  to  delayed  or  scanty  menstruation,  frigidity, 
sexual  apathy  and  sterility.  Equally  important  is  dysmen- 
orrhea  in  its  various  manifestations.  The  underlying  dis- 
order may  be  early  and  spontaneous  in  origin,  or  it  may  be 
a  later,  acquired  condition ;  i.  e.,  the  change  may  be  initiated 
sufficiently  early  to  prevent  the  normal  development  and 
growth  dependent  thereon,  or,  on  the  other  hand,  ovarian 
disease  may  supervene  after  maturity  with  an  obviously 
modified  train  of  results.  The  former  condition  naturally 
implies  a  wider  and  more  fundamental  symptomatology,  for 
the  changes  of  puberty  are  purely  of  endocrine  origin  and 
the  ovaries  are  among  the  principal  agencies  in  bringing 
them  about.  The  results  of  early  ovarian  insufficiency  are 
combined  and  generally  known  as  "infantilism."  The  usual 
findings  include  delayed  or  arrested  growth  of  the  body  as  a 
whole  and  of  the  reproductive  organs  in  particular.  The 
breasts  may  be  small  and  undeveloped,  though  not  infre- 
quently this  does  not  appear  to  be  the  case,  especially  when 
there  is  plenty  of  fat  in  the  tissues.  The  hips  are  narrow. 
The  pubic  and  axillary  hair  is  scanty  or  absent;  and  the 
psycho-sensory  sex  evidences  are  diminished  or  absent. 


OVARIAN  DYSCRINISM  135 

The  later  onset  of  ovarian  insufficiency  is  not  accompa- 
nied by  such  well  marked  evidences,  at  least  as  far  as 
physical  development  is  concerned,  for  obvious  reasons; 
but  the  functional  changes  are  usually  clearly  discernible. 
Since  the  growth  of  the  myometrium  and,  in  fact,  the  pelvic 
circulation  and  reproductive  development  are  under  hor- 
mone control,  in  case  of  ovarian  insufficiency  the  uterus  may 
be  expected  to  be  infantile  (or  "senile")  and  the  adnexa 
undeveloped  or  atrophied.  Where  this  is  acquired  later  in 
life,  genital  atrophy  is  to  be  seen  as  a  shrinking  of  the  in- 
ternal and  external  genitalia.  The  labia  majora  diminish  in 
size,  while  the  labia  minora  are  slender  and  insignificant  and 
may  disappear  entirely.  The  introitus  narrows  and  tends  to 
become  valve-like,  and  the  modified  vaginal  membrane  is 
thin,  pale  and  mottled,  later  becoming  tough  and  unyielding. 
The  vagina  contracts  and  obstructing  bands  may  be  formed, 
while  the  cervix  shrinks  and  its  lumen  tends  to  close. 

Typical  Functional  Ovarian  Insufficiency.  A  more  or  less 
typical  case  of  deficient  ovarian  functioning  may  be  out- 
lined: The  patient  complains  of  uncomfortable  sensations, 
such  as  pelvic  heaviness,  vague  nervous  manifestations  and 
a  feeling  of  general  malaise  of  varying  degree  for  a  longer  or 
shorter  time  prior  to  each  expected  menstruation.  Delay 
is  the  rule.  Irregularity  of  onset  and  a  scant  flow  are  cus- 
tomary. During  the  "over"  period  she  may  and  indeed  often 
does  suffer  from  severe  colds,  an  old  tonsilitis  lights  up, 
headaches  of  quite  decided  severity  are  common,  boils  or 
acne  are  sometimes  found  and,  in  fact,  the  patient  is  so 
tired  and  below  par  at  that  time  that  during  it  any  latent 
condition  may  become  aggravated  because  of  the  temporar- 
ily lowered  resistance.  When  the  menses  do  show  up  and 
get  properly  started,  these  troubles  begin  to  disappear — 
until  the  next  premenstrual  delay.  And  so  on.  The  delayed 
menstruation  favors  a  condition  of  neurasthenia  and  worry 
which  adds  to  the  aggravation  all  around. 

It  is  easy  to  see  that  neuroses  are  common  in  those  suffer- 
ing from  dysovarism.  Many  sympathetic  nervous  disorders, 
well  defined  as  well  as  vague,  have  a  large  ovarian  element 
in  their  make-up.  Many  cases  called  "neurasthenia"  and 
many  "reflex"  mental  and  physical  ills  are  connected  in 
some  direct  or  remote  way  with  the  menstrual  ovarian  func- 
tion. Occasionally  these  develop  into  psychoses,  which  may 
or  may  not  respond  to  organotherapy.  The  fact  that  they 
are  related  in  some  way  to  ovarian  physiology  (or  path- 
ology), that  they  are  influenced  by  conditions  involving 


136  PRACTICAL  ORGANOTHERAPY 

menstruation,  intercourse,  pregnancy  or  psycho-sexual  mat- 
ters should  be  proof  enough.  The  best  kind  of  conviction, 
however,  comes  from  developing  a  supposition  into  a  reality 
by  initiating  the  right  kind  of  treatment — in  this  instance, 
in  my  estimation,  pluriglandular  therapy — and  controlling 
the  manifestations,  a  thing  that  has  been  done  times  with- 
out number. 

Menopausal  Difficulties.  When  hormone  production  ceases 
at  the  "change  of  life,"  the  delicate  hormone  balance,  the 
mechanism  of  which  has  depended  upon  ovarian  hormone 
activity  for  approximately  thirty  years,  sometimes  is  sadly 
deranged,  causing  considerable  disturbance  in  the  work  of 
the  other  ductless  glands.  The  extent  of  this  trouble  de- 
pends very  largely  (1)  upon  the  previous  ovarian  hormone 
production,  and  a  person  who  had  been  accustomed  to  quite 
considerable  ovarian  activity  might  react  less  favorably 
than  where  this  activity  had  been  less ;  (2)  the  rapidity  of 
the  completion  of  this  function  (a  sudden  menopause,  like 
the  "surgical  menopause,"  is  likely  to  be  more  severe  than 
when  the  transition  is  more  gradual),  and  (3)  the  sensi- 
tiveness of  the  associated  glands,  especially,  in  my  estima- 
tion, the  adrenal  glands,  which,  it  will  be  recalled,  are  un- 
usually sensitive  to  toxemia,  acidosis  and  emotional  factors. 

The  organic  changes  are  too  well  known  to  require  reit- 
eration here  and  include  most  of  the  retrograde  anatomical 
changes  previously  mentioned.  The  chief  symptoms  of  this 
condition  are  of  a  circulatory  character,  due  in  all  proba- 
bility to  the  indirect  influences  upon  the  adrenal  glands. 
Reflex  troubles  are  often  found,  the  most  common  of  which 
is  headache,  probably  of  circulatory  origin,  although  more 
than  one  case  of  post-climacteric  headache  has  been  known 
to  be  due  to  pituitary  dysfunction,  resulting,  in  all  prob- 
ability, from  an  attempt  of  the  pituitary  gland  to  make  up 
for  the  ovarian  deficiency — a  "friendly"  activity  which  is 
not  always  best  for  the  patient.  Flushes  of  heat,  fleeting 
and  indefinite  pains,  sensory  disturbances  in  various  local- 
ities, pelvic  fullness  due  to  congestion  with  frequent  periods 
of  menorrhagia,  sympathetic  irritability,  on  the  one  hand, 
or  melancholia  and  depression,  on  the  other,  make  up  a 
symptom-complex  which  is  often  called  neurasthenia  but 
which  is  nothing  in  the  world  but  dyscrinism — a  disordered 
function  of  the  glands  of  internal  secretion  due  to  the  im- 
balance between  the  ovaries  and  the  other  glands. 

Functional  Sterility.  With  the  changes  enumerated  above, 
one  would  expect  to  find  sterility,  and  this,  of  course,  is  the 


OVARIAN  DYSCRINISM  137 

rule  at  the  menopause.  Indeed,  the  endocrine  glands  have 
much  to  do  to  enable  the  uterus  to  house  an  impregnated 
ovum  seeking  a  lodging  place,  and  many  cases  01  presum- 
ably normal  ovulation,  with  or  without  menstrual  difficul- 
ties, are  sterile  because  the  ovum  is  lost.  Indeed,  this 
form  of  sterility  may  be  the  only  sign  of  ovarian  insuf- 
fiency,  and  there  certainly  must  be  many  early  abortions 
in  which  the  cause  is  not  so  much  defective  ovulation  (syph- 
ilis having  been  ruled  out)  as  a  difficulty  in  the  proper  im- 
plantation of  an  apparently  normal  embryo,  a  function 
which  is  now  conceded  to  be  made  possible  through  hormone 
influences  and  which,  fortunately  indeed,  occasionally  may 
be  remedied  by  suitable  organotherapy. 

The  endocrine  aspect  of  sterility  and  the  organotherapeu- 
tic  remedying  of  this  condition  are  subjects  which  are  being 
given  close  attention  at  this  time,  and  within  the  last  year 
several  very  comprehensive  articles  have  been  written,  per- 
haps the  most  interesting  of  which  is  by  S.  W.  Bandler, 
of  New  York. 

From  my  own  standpoint,  sterility,  even  of  a  most  per- 
sistent character,  is  not  nearly  such  an  impossible  condition 
as  has  been  supposed.  I  have  personally  seen  a  number  of 
cases  in  which  every  anatomical  feature  was  normal — the 
chemistry  of  the  vaginal  secretion  was  ruled  out  as  a  factor 
— but  there  was  a  subtle  dysthyroidism  which  was  only  dis- 
covered by  the  use  of  my  thyroid  function  test  (see  Sec. 
IV,  Chap.  4),  and  upon  the  initiation  of  a  comparatively 
short  course  of  suitable  organotherapy,  the  desired  impreg- 
nation occurred.  With  this  thought  in  mind,  it  may  be  well 
to  recall  some  things  that  have  already  been  said  about  the 
thyroid,  pituitary  and  ovarian  functions.  Myxedema  and 
the  less  serious  forms  of  thyroid  insufficiency  spell  ovarian 
insufficiency,  amenorrhea — and  sterility.  The  typical  pelvic 
findings  in  hypopituitarism  are  a  functional  ovarian  insuf- 
ficiency and,  later,  atrophy  of  the  whole  genital  system. 
There  is  also  a  pituitary  element  in  sterility.  Possibly  other 
glands  are  also  involved,  but  it  is  certainly  true  that  the  con- 
sideration of  the  "endocrine  trinity  of  sex,"  the  ovary,  thy- 
roid and  pituitary  glands,  opens  up  a  fertile  field  for  the 
clinical  treatment  of  many  functional  pelvic  difficulties,  in- 
cluding sterility,  and  attention  is  called  to  three  chapters  on 
ovarian  disorders  (Sec.  V,  Chaps.  5,  6  and  7),  in  which 
reference  is  made  to  two  formulas,  the  one  No.  4,  Thyro- 
Ovarian  Co.  (Harrower)for  the  regulation  of  the  ordinary 
disturbances  of  ovarian  function,  and  No.  73,  Gonad-Ovar 


138  PRACTICAL  ORGANOTHERAPY 

rian  Co.  (Harrower)  (containing  anterior  pituitary  sub- 
stance in  addition)  for  the  more  definite  cases  of  sterility 
and  sexual  apathy,  including  those  in  which  ovarian  therapy 
and  the  thyro-ovarian  formula  have  been  tried  for  some 
months  without  a  satisfactory  outcome. 

Over-secretion  of  the  Ovaries.  Excessive  ovarian  activity 
is  not  nearly  so  frequent  as  hypo-ovarism.  Rarely  in  early 
life  it  may  accompany  pituitary  disease,  abnormal  thymus 
atrophy  or  a  pineal  tumor,  and  as  a  result  of  the  dyscrinism 
the  ovaries  may  commence  to  functionate  very  early  or  ab- 
normally. Cases  are  on  record  where  the  evidences  of  pu- 
berty were  present  at  five  years,  and,  from  the  standpoint 
of  fecundity,  while  procreation  may  not  have  been  possible, 
at  least  such  cases  were  rightly  classed  as  "precocious." 
For  reasons  that  may  not  be  always  clear,  psychic,  endocrine 
or  organic,  the  ovaries  may  function  excessively,  as  a  result 
of  which  those  factors  dependent  upon  ovarian  function  are 
increased,  including  sexuality,  which  may  develop  into  all 
kinds  of  sexual  perversion,  and  menorrhagia.  This  latter 
may  be  represented  by  too  frequent  menstruation  or  by  an 
excessive  flow  at  proper  intervals.  There  may  be  varying 
degrees  of  pelvic  sensitiveness  and  pain,  with  a  sense  of 
uncomfortable  fullness  in  the  lower  abdomen  due  to  con- 
gestion. This  same  circulatory  derangement  results  in  ir- 
ritation of  the  external  genitalia,  and  the  sympathetic  bal- 
ance may  be  so  badly  disturbed  that  hysteria  may  be  directly 
due  to  this  disturbance. 

The  adrenal  glands  may  be  so  excessively  stimulated  by 
this  abnormal  production  of  the  ovarian  hormone  that  they 
may  be  depleted,  and  following  the  condition  of  adrenal 
irritability  and  sympatheticotonus  there  may  be  long  pe- 
riods of  adynamia  and  asthenia  so  common  in  certain  ova- 
rian cases.  It  should  be  remarked  in  passing  that  numer- 
ous other  circumstances  may  be  the  cause  of  adrenal  de- 
pletion; and  the  consequent  asthenia,  while  accompanying 
other  evidences  of  hyperovarism,  really  may  be  due  to  other 
remote  causes.  Functional  hyperovarism  is  practically 
never  existent  without  associated  sexual  neuroses,  and  it 
may  include  masturbation  and  nymphomania,  even  growing 
into  "sexual  insanity."  Several  years  ago  the  writer  sug- 
gested a  therapeutic-diagnostic  test  which  is  well  worth 
trying  in  hyperovarism.  Functional  menorrhagia  and  other 
conditions  purely  due  to  ovarian  excess  (not  to  new  growths 
or  to  mechanical  causes)  are  often  modified  by  mammary 
organotherapy.  Five  to  ten  grains  of  desiccated  mammary 


OVARIAN  DYSCRINISM  139 

gland  given  three  times  .a  day  before  meals  have  controlled 
the  hemorrhage  and  pelvic  uncomfortableness  very  nicely. 
At  the  same  time  this  assists  in  establishing  the  functional 
basis  of  the  disorder.  (Parenthetically,  the  internal  secre- 
tion of  the  mammary  glands  exerts  an  antagonistic  action 
over  that  of  the  ovaries — see  Sec.  V,  Chap.  9 — as  does  that 
of  the  pancreas  over  the  secretion  of  the  adrenal  medulla.) 

Osteomalacia  an  Ovarian  Symptom.  One  of  the  chemical 
results  of  hyperovarism  is  especially  noticeable  in  osteo- 
malacia.  This  lack  of  lime  and  softening  of  the  bones  is 
now  known  to  be  intimately  connected  with  the  glands  of 
internal  secretion  and  particularly  the  ovaries.  Osteomala- 
cia may  be  brought  about  directly  by  ovarian  excess  (and 
be  remedied  very  largely  by  removal  of  a  portion  of  the 
hyperactive  glands  just  as  the  thyroid  is  removed,  in  part, 
in  hyperthyroidism,  etc.).  In  these  cases,  the  disordered 
calcium  metabolism  is  due  probably  to  the  abnormal  excre- 
tion of  the  lime  brought  about  by  the  undue  ovarian  stimuli. 
Blair  Bell  has  shown  by  numerous  experiments  that  the 
ovaries  are  an  important  factor  in  the  regulation  of  the 
power  of  the  organism  to  appropriate  calcium;  and  the 
clinical  experiences  with  osteomalacia  seem  to  prove  his  con- 
tention. This  condition  is  not  usual  in  non-pregnant  women 
as  they  do  not  have  the  great  need  for  lime  that  is  present 
during  pregnancy;  but  since  child-bearing  causes  a  large 
demand  for  extra  lime,  softening  of  the  bones  may  occur  and 
is  not  uncommon  in  Italy,  Austria  and  India.  At  one  time, 
osteomalacia  was  routinely  treated  by  oophorectomy,  but 
since  Bossi,  in  1907,  first  suggested  the  administration  of 
an  antagonizing  hormone  instead  of  ovarian  removal,  adre- 
nal substance  has  been  given  with  many  resulting  cures. 
More  recently  Blair  Bell  has  directed  the  treatment  of  a 
series  of  cases  in  India,  at  long  range,  and  at  his  suggestion 
the  posterior  pituitary  principle  has  been  given  in  osteomal- 
acia with  distinct  benefit  in  a  number  of  cases.  This  seems 
to  indicate  that  osteomalacia  is  likely  a  pluriglandular  dis- 
order, the  hyperovarism  being  coupled  with  hypoadrenia  or 
hypopituitarism.  This  is  undoubtedly  the  case  and  indi- 
cates a  prospective  method  in  hyperovarism  where  treat- 
ment is  unavailing  and  operation  inadvisable. 

The  Causes  of  Ovarian  Excess.  The  first  cause  of  hyper- 
ovarism is  functional  irritability  due  to  the  circulatory  de- 
rangement accompanying  pelvic  inflammation  or  malposition 
of  the  uterus.  Another  common  cause  is  connected  with 
hygienic  conditions  of  a  personal  nature,  involving  associa- 


140  PRACTICAL  ORGANOTHERAPY 

tions,  reading  and  various  sex  circumstances.  These  two 
factors,  mechanical  and  psychic,  induce  a  condition  of  cir- 
culatory stasis  which  is  equally  the  result  of  infections, 
uterine  subinvolution  and  malpositions.  This  stasis  is  a 
common  cause  of  ovarian  disease  which  is  first  functional 
and  later  organic. 

The  Ovarian  Element  in  Fibroids.  A  number  of  years 
ago,  surgical  removal  of  the  ovaries  was  recommended  for 
the  control  of  the  uterine  fibroids  and  the  accompanying 
menorrhagia.  It  is  well  known  that  the  menopause  fre- 
quently alters  the  symptoms  of  fibroid  growths  and  causes 
a  cessation  of  their  growth  or  a  reduction  in  size.  Ovarian 
antagonism  by  the  X-ray  is  a  frequent  recourse  in  fibroid 
menorrhagia;  likewise,  organotherapy  opposed  to  ovarian 
hormone  function  reduces  the  symptoms. 

All  of  these  facts  lend  weight  to  the  belief  that  uterine 
fibroids  are  possibly  the  result  of  hyperovarism,  and,  among 
others,  Briggs,  of  Sacramento,  believes  that  the  exciting 
cause  of  these  new  growths  and  the  accompanying  hemor- 
rhages is  uterine  hyperemia  of  ovarian  origin  and  that  the 
antagonistic  effect  of  the  mammary  principle  is  helpful  be- 
cause of  its  anti-ovarian  influence.  Briggs  reports  a  number 
of  clinical  experiences  to  establish  his  theory  and  states  that 
in  "a  large  majority  of  cases  receiving  mammary  extract, 
the  menorrhagia  is  effectively  controlled  and  under  its  con- 
tinued use  large  uterine  fibroids  often  disappear,  even  dur- 
ing the  early  reproductive  period."  The  mammary  hor- 
mone probably  antagonizes  the  follicular  (stromal)  hormone 
or  inhibits  its  production  and  thus  moderates  or  prevents 
an  excessive  menstrual  molimen  and  its  consequent  hypere- 
mia, menorrhagia  and  local  nutritive  disturbances.  The  ef- 
fective dosage  therefore  would  seem  to  depend  on  the  degree 
of  excessive  ovarian  activity — the  greater  this  functional 
activity,  the  larger  the  quantity  of  mammary  extract  re- 
quired to  inhibit  or  antagonize  it. 

This  conception  of  the  cause  and  treatment  of  fibroids  has 
been  successfully  carried  out  by  many  physicians  (see  Sec. 
V,  Chap.  9,  "The  Control  of  Menorrhagia"),  and  the  use  of 
No.  40,  Mamma-Pituitary  Co.  (Harrower)  is  recommended 
because  each  of  the  ingredients  favors  uterine  depletion  and 
encourages  pelvic  tone,  while  the  mammary  extract  is  a 
direct  "anti-ovarian"  remedy. 

Organic  Ovarian  Disease.  Local  structural  changes  in  the 
ovaries  themselves  are  very  numerous  and  they  really  form 
a  third  class  of  cases  of  ovarian  dysfunction,  for  the  exces- 


DISEASES  OF  THE  THYMUS  141 

sive  endocrine  activity  is  not  so  much  an  increase  in  the 
normal  production  of  the  ovarian  hormones  as  the  actual 
production  of  aberrant  chemical  substances  from  new 
growths  or  cysts  in  the  ovaries.  The  frequency  of  ovarian 
tumors  is  responsible  for  this,  the  condition  is  differen- 
tiate from  hyperovarism,  and  the  clinical  findings  are 
irregular  since  this  disorder  may  be  accompanied  by  periods 
of  ovarian  excess  or  insufficiency.  Occasionally  there  is 
produced  in  the  ovarian  tissue  (either  in  the  normal  inter- 
stitial or  luteal  cells,  or  in  those  of  the  new  growth)  a  toxic 
hormone  of  extreme  virulence,  and  in  comparatively  recent 
German  literature  the  term  "ovarian  poisoning"  is  found, 
denoting  a  vicious  activity  of  diseased  ovarian  tissue  with 
serious  remote  effects  due  to  the  poison  produced  there  and 
secreted  directly  into  the  blood  stream  as  are  practically  all 
the  hormone-bearing  internal  secretions.  The  treatment, 
of  course,  involves  the  removal  of  the  offending  tissue. 

Dysovarism  may  be  the  cause  of  alternate  periods  of 
amenorrhea  and  menorrhagia.  Dysmenorrhea  is  the  rule. 
Neurotic  manifestations  are  quite  usual,  and  some  have  re- 
ported insanity  as  one  of  the  possible  results  of  this  variety 
of  ovarian  derangement,  incidentally  explaining  some  re- 
markable "cures"  of  insanity  following  surgery  of  the  ovar- 
ies. Under  certain  circumstances  an  abnormal  menopause 
virtually  develops  into  a  minor  form  of  dysovarism,  the 
varying  symptoms  being  due  to  irregular  periods  of  differ- 
ing ovarian  activity. 

The  most  common  symptoms  of  dysovarism  are  pain  in 
the  pelvis  and  severe  asthenia.  The  extreme  prostration 
and  weakness  is  doubtless  due  to  a  superinduced  hypoa- 
drenia,  and  may  be  the  outstanding  feature  of  a  case.  In 
most  cases,  on  bimanual  palpation,  the  offending  organ  or 
organs  frequently  will  be  found  to  be  nodular,  irregular,  en- 
larged and  tender.  Here  again  surgery  is  proper. 


SECTION  IV.    CHAPTER  9 
THE  DISEASES  OF  THE  THYMUS 


Disorders  of  the  thymus  gland  are  not  common,  though 
they  are  undoubtedly  more  frequent  than  is  supposed. 
There  always  has  seemed  to  be  an  element  of  mystery  about 
this  gland,  due  possibly  to  the  strangeness  and  suddenness 


142  PRACTICAL  ORGANOTHERAPY 

of  deaths  of  thymic  origin.  However,  this  is  being  replaced, 
and  we  are  now  able  to  understand  the  thymus  better  than 
we  did  a  few  years  ago. 

As  with  the  other  ductless  glands,  we  may  find  a  cellular 
enlargement  of  the  thymus  with  local  symptoms  due  to  pres- 
sure; or,  on  the  other  hand,  there  may  be  a  change  in  the 
functional  activities  of  the  gland  with  varying  effects  upon 
the  body  as  a  whole.  It  is  not  generally  conceded  that  the 
thymus  is  really  a  gland  of  internal  secretion,  although  it 
influences  metabolism  and  also  the  work  of  the  other  duct- 
less glands  in  a  manner  very  similar  to  other  known  endo- 
crine glands. 

It  has  been  suggested  that  the  principal  function  of  the 
thymus  is  to  produce  lymphocytes,  and  Sajous,  of  Philadel- 
phia, believes  that  any  effects  that  it  may  exert  upon  met- 
abolism, positive  or  negative,  are  due  to  these  cells  or  their 
contents.  Of  course,  it  is  quite  possible  that  these  blood 
cells  carry  within  themselves  certain  chemical  substances 
which  are  very  closely  allied  to  hormones,  if  not  actually 
such. 

Physiological  Considerations.  Most  authorities  consider 
the  thymus  as  a  temporary  organ  which  reaches  its  height 
of  development  about  the  age  of  two,  and  retrogrades  slowly 
until  puberty,  at  which  time  it  is  supposed  to  disappear, 
though  this  opinion  is  not  unanimous.  Proof  that  the  thy- 
mus is  not  a  lymphoid  organ  alone  is  found  in  the  intimate 
relation  between  the  thymus  and  the  metabolism  of  the 
mineral  salts,  especially  of  calcium  and  phosphorus;  for 
when  there  is  early  or  experimental  thymus  dysfunction  the 
chief  organs  to  suffer  from  the  resultant  chemical  changes 
are  the  bones,  muscles  and,  perhaps,  the  nerves,  in  the  order 
named. 

There  is  an  abundance  of  evidence  connecting  the  activ- 
ities of  the  thymus  with  those  of  the  gonads.  It  seems  that 
the  thymus  antagonizes  the  action  of  the  sex  glands,  and 
that  increased  thymus  function,  especially  during  the 
period  of  development,  causes  deficient  development  of  the 
reproductive  organs ;  while,  on  the  other  hand,  deficient  thy- 
mus activity  may  cause  an  increase  in  the  growth  and  func- 
tion of  the  gonads.  At  least  we  know  that  if  the  thymus 
does  not  retrograde  in  the  usual  manner  at  puberty  there 
likely  may  be  evidences  of  defective  sexual  development, 
and  from  this  the  conclusion  is  drawn  that  the  study  of  the 
thymus  should  be  a  part  of  the  study  of  all  cases  of  de- 
ficient gonad  function  or  development. 


DISEASES  OF  THE  THYMUS  143 

Another  important  clinical  fact  which  indicates  another 
physiologic  intimacy  of  the  thymus,  is  found  in  its  relation 
to  idiocy  in  children.  It  has  been  remarked  that  a  large 
percentage  of  idiotic  children  have  no  thymus  at  all.  Morel 
reports  that  of  over  four  hundred  idiotic  children  with  nor- 
mal thyroids  coming  to  autopsy,  over  75  per  cent  possessed 
no  thymus.  In  passing,  it  is  interesting  to  note  that  Klose 
has  experimentally  shown  that  thymectomy  in  dogs  is  fol- 
lowed by  a  gradual  change  in  the  mental  powers  until  a  con- 
dition whch  he  terms  idiotia  thymopriva  is  present.  While 
this  does  not  necessarily  prove  that  athymia  is  the  cause  of 
idiocy,  it  is  at  least  a  very  suggestive  finding  and  one  which 
has  been  well  established  by  many  investigators. 

Thymus  Insufficiency.  Experimental  proof  is  at  hand  to 
show  that  the  removal  of  the  thymus  from  animals  causes 
a  decided  reduction  of  growth — dwarfism.  It  is  not  im- 
proper to  presume  that  this  holds  good  with  children.  At 
least  there  is  a  probable  thymic  element  in  dwarfism,  and 
support  of  this  is  found  in  several  communications  which 
report  benefit  following  thymus  feeding  in  certain  cases 
where  the  weight  was  low  and  the  height  reduced. 

Certain  nutritional  disorders  in  children,  notably  maras- 
mus, are  quite  commonly  associated  with  thymic  atrophy, 
and  some  interesting  clinical  proof  of  this  is  available.  De- 
ficient children,  especially  when  there  are  disturbances  in 
bone  growth  and  development,  should  always  be  considered 
from  the  thymus  aspect  until  definitely  proved  not  to  be 
suffering  from  hyppthymism.  Parenthetically  my  formula 
No.  2,  Antero-Pituitary  Co.,  which  is  recommended  in  the 
treatment  of  defective  children,  contains  an  effective  dose 
of  thymus  substance.  (See  Sec.  V,  Chap.  11.) 

Naturally  hypothymism  is  not  to  be  expected  in  adults 
for  the  gland  normally  becomes  inactive  at  or  near  puberty. 
However,  individuals  with  thymus  dyscrasias  in  childhood 
may  retain  certain  chemico-nutritional  disorders  as  a  result 
of  the  previous  disordered  function  of  this  gland. 

The  blood  changes  are  not  characteristic;  but  one  fre- 
quently finds  hypothymism  accompanied  by  anemia  and 
especially  lymphocythemia.  Reduced  coagulability  is  also 
common  and  frequent  bleeding  at  the  nose  may  be  the  first 
indication  of  thymus  disorder.  Still  another  incidental  de- 
fect has  been  connected  with  dysthymism.  Browning  states 
that  there  is  a  relationship  between  the  thymus  gland  and 
stammering.  While  all  cases  with  an  enlarged  thymus  do 
not  stutter,  all  stutterers  will  be  found  to  have  an  enlarged 


144  PRACTICAL  ORGANOTHERAPY 

gland.  This  is  denied  by  some,  but  is  worth  remembering. 
After  all,  success  in  the  detection  and  treatment  of  duct- 
less glandular  disorders  is  attained  by  noting  insignificant 
things. 

One  frequently  notes  a  peculiar  condition  of  hairlessness 
(especially  of  the  head  and  face),  and  a  yellowish,  parch- 
ment-like skin  in  pluriglandular  dyscrasias  in  which  the 
thymus  element  is  or  has  been  prominent.  Parenthetically 
it  may  be  well  to  remark  that  Sajous  suggests  that  the 
rare  condition  known  as  progeria  or  premature  senility  (in 
children),  is  really  due  to  thymus  disease. 

Some  of  the  findings  in  experimental  and  clinical  work 
are  sometimes  contradictory,  and  the  reason  for  this  is  due 
to  the  fact  that  the  endocrine  organs  are  so  intimately  con- 
nected with  one  another.  At  one  time  a  certain  hormone 
seems  to  be  in  the  ascendancy,  whereas  at  another,  it  is  defi- 
cient. As  an  instance  of  this  a  case  of  presumed  hypo- 
thymism  with  retarded  growth  and  sexual  development  was 
treated  with  thymus  substance  for  some  months  with  a 
remarkable  increase  in  height  and  general  progress,  though 
it  must  be  recalled  that  theoretically  the  removal  of  the 
antagonism  of  the  thymus  (as  in  hypothymism) ,  should 
favor  functional  gonad  activity  and  the  developmental  and 
other  results  thereof. 

Hyperthymism.  Hyperthymism  is  not  a  common  or 
easily  diagnosed  condition.  It  is  rarely  found  unaccom- 
panied by  other  ductless  glandular  disorders;  indeed  it  is 
a  disorder  which  one  should  be  ready  to  look  for  mainly  in 
connection  with  certain  forms  of  thyroid  excess.  A  number 
of  reports  indicate  that  one  should  carefully  look  for  an 
enlarged  thymus  and  evidences  of  its  excessive  activity  in 
every  case  of  Graves's  disease,  and  particularly  before  sur- 
gical intervention  is  undertaken.  After  a  careful  search 
both  of  the  literature  and  numerous  unpublished  hos- 
pital records,  Matti  collated  133  cases  of  sudden  death  in 
hyperthyroidism  in  which  a  post  mortem  examination  had 
been  held  and  in  98  cases,  or  74  per  cent,  a  hyperplastic  thy- 
mus was  found.  Such  records  emphasize  the  advice  just 
given  regarding  the  relation  of  thymus  disorder  with 
Graves's  disease. 

A  number  of  deaths  have  followed  thyroid  operations,  due 
to  thymus  complications.  Not  a  few  times  a  share,  at  least, 
of  the  heart  and  nervous  symptoms  attributed  to  hyper- 
thyroidism has  been  due  to  a  concomitant  hyperthymism. 
In  this  connection  it  must  be  emphasized  that  while  an  en- 


DISEASES  OF  THE  THYMUS  145 

larged  thymus  may  be  usual  in  such  cases,  there  is  no  doubt 
that  the  degree  of  thymotoxemia  may  have  little  to  do  with 
the  size  of  the  gland. 

Experimentally  and  clinically,  excessive  thymus  function 
is  accompanied  by  severe  general  nervousness,  tremor  and 
a  rapid,  irregular  pulse.  Thymotoxemia  of  this  character 
may  be  amenable  to  roentgenization  of  the  thymus  area. 

There  is  a  somewhat  rare  thymus  type  of  adiposity  which 
is  usually  accompanied  by  lymphatic  tendencies,  and  in 
which  one  often  may  find  a  well  defined  thymus  area  on 
X-ray  examination.  In  such  cases  myasthenia  is  persis- 
tent and  may  disappear  after  suitable  treatment — Roentgen 
or  surgical. 

In  cases  of  thymus  disorder  one  usually  will  find  a  con- 
siderable increase  in  the  number  of  lymphocytes  in  the 
differential  blood  count,  and  this  procedure  is  recommended 
not  merely  when  thymus  disease  is  suspected,  but  in  the 
routine  clinical  diagnosis  of  Graves's  disease. 

According  to  Paltauf  the  characteristic  features  of  hyper- 
thymism  are:  (1)  Hyperplasia  of  the  various  groups  of 
lymph  glands,  tonsils,  spleen,  and,  of  course,  the  thymus 
itself  (see  status  thymo-lymphaticus) ;  (2)  Lymphocytosis, 
the  count  being  increased  to  50  per  cent  or  more  (i.  e.,  in- 
creased 100  per  cent  or  more);  (3)  Cardio-aortic  aplasia; 
(4)  Maldevelopment  of  the  genital  glands  and  their  adnexa; 
and  (5)  A  pale,  badly  nourished  skin  with  scanty  hair  and 
an  exaggerated  panniculus  adiposus.  It  is  fair  to  add 
that  one  rarely  finds  all  these  in  a  single  case. 

Diagnostic  Points  in  Thymus  Cases.  Attention  already 
has  been  called  to  the  value  of  the  Roentgen  ray  in  the 
diagnosis  of  thymus  disorder.  An  enlarged  thymus  occa- 
sionally may  be  percussed  as  a  triangular  area  of  dullness 
under  the  manubrium  of  the  sternum,  in  some  cases  ex- 
tending outward  on  either  side  a  short  distance.  This  area 
of  dullness  may  move  slightly  upward  on  extending  the 
neck  by  drawing  the  head  well  back.  The  base  of  this  tri- 
angle is  between  the  sternal  ends  of  the  clavicles,  and  the 
apex  between  the  junctions  of  the  sternum  with  the  second 
and  third  ribs.  Halstead  has  noticed  that  downward  pres- 
sure on  the  sternum  may  produce  a  sense  of  suffocation  in 
cases  of  this  character,  which  differs  considerably  from  the 
normal. 

It  should  be  recalled  that  there  is  such  a  condition  as  a 
sub-sternal  goitre  or  an  intrathoracic  thyroid ;  but  this  may 
be  differentiated  by  the  somewhat  higher  position  of  the 

10 


146  PRACTICAL  ORGANOTHERAPY 

enlargement  and  the  fact  that  it  moves  with  the  trachea  in 
the  act  of  swallowing. 

Hoxie  has  described  a  symptom-complex  in  which  an  en- 
larged thymus  is  accompanied  by  shortness  of  breath  and 
discomfort  in  the  thorax,  and  extreme  muscular  weakness. 
In  several  cases  reported,  the  asthenia  was  quite  the  most 
prominent  subjective  finding.  This  is  of  special  interest, 
as  there  seems  to  be  clinical  evidence  that  myasthenia 
gravis  is  in  some  way  connected  with  the  thymus.  Tom 
Williams  has  reported  a  case  of  a  man  with  this  disease 
who  was  apparently  cured  by  the  administration  of  thymus. 

Thymus  Hyperplasia  in  Children.  We  have  already  dis- 
cussed thymus  enlargement  and  hyperactivity ;  but  thymus 
hyperplasia  in  children  deserves  mention  by  itself.  It  seems 
to  be  a  somewhat  different  clinical  entity  not  uncommonly 
found  in  infants  and  children  and,  unfortunately,  too  often 
only  at  the  autopsy  table.  Many  times  this  hyperplasia 
causes  no  well  defined  symptoms  and  is  altogether  latent 
until  sudden  death,  the  so-called  "mors  thymica"  is  the 
first  indication  that  something  was  wrong. 

In  infants,  where  an  enlarged  thymus  is  present,  the  in- 
itiation of  breathing  may  be  a  prolonged  and  difficult 
matter.  The  cyanosis  present  at  birth  may  persist  and  the 
breathing  may  be  difficult  and  stridorous.  In  such  cases 
the  outcome  is  often  fatal  after  a  few  hours  or  days. 

Dyspnea  in  children  is  probably  the  most  marked  symp- 
tom of  thymus  hyperplasia,  and  its  presence  should  always 
cause  a  careful  search  for  other  associated  findings.  It  may 
vary  in  degree,  depending  upon  the  pressure,  from  an  insig- 
nificant stridor,  worse  on  stretching  the  neck  or  drawing 
back  the  head,  to  a  serious  and  alarming  air  hunger. 

In  such  cases  the  general  health  is  poor.  The  skin  has 
a  pasty,  badly  nourished  appearance,  not  unlike  that  of 
cretinism.  There  may  be  vague  respiratory  symptoms  due 
to  tracheostenosis,  which  later  may  develop  into  a  peculiar 
harsh  and  intermittent  cough  which  is  sometimes  erron- 
eously called  a  "tooth"  cough,  a  "stomach"  cough  or,  for 
lack  of  a  better  name  a  "nervous  cough."  This  cough  occa- 
sionally may  be  short  and  dry  during  the  day  and  consider- 
ably worse  at  night.  It  is  possible  that  the  cough  may  not 
be  due  to  pressure  on  the  air  passages,  but  to  irritation  of 
either  the  recurrent  laryngeal  or  vagus  nerves,  although 
trachea!  stenosis  is  the  most  usual  cause. 

Status  Thymo-Lymphaticus.  This  disorder  differs  some- 
what from  thymus  hyperplasia  since  it  is  evidently  an  ac- 


DISEASES  OF  THE  THYMUS  147 

quired  condition  and  is  more  frequently  observed  in  older 
children  and  young  adults.  It  is  a  more  complex  condition, 
the  hypertrophic  changes  in  the  thymus  being  accompanied 
by  a  general  enlargement  of  the  bronchial,  mesenteric  and 
other  lymphatic  glands.  According  to  Hart,  the  existence 
of  a  true  status  lymphaticus  has  not  yet  been  proved  with 
absolute  certainty.  To  him  it  appears  that  the  swelling  of 
the  lymphatic  apparatus  represents  a  tissue  reaction  de- 
pendent on  the  thymus  and  which  may  show  itself  also  in 
the  lymphoid  components  of  the  thymus  itself. 

Adenoids  and  enlarged  tonsils  are  usual,  hence  cases  with 
a  well  marked  adenoid  facies  and  other  evidences  of  lym- 
phatic enlargement  should  be  studied  as  likely  cases  of 
status  lymphaticus  and  the  thymus  should  be  sought  for 
and,  if  possible,  measured.  According  to  Bierring  and 
others,  inexplicable  deafness  has  been  found  in  a  number 
of  cases. 

In  the  past,  status  thymo-lymphaticus  commonly  has  been 
diagnosed  after  sudden  and  unexplained  death.  We  are 
now  better  informed  about  the  symptomatology  of  thymus 
dyscrasias,  and  with  increasing  frequency  this  condition  is 
detected  before  extreme  results  show  themselves  and  in 
time  to  treat  the  thymus  with  the  Roentgen  ray. 

Individuals  with  status  thymo-lymphaticus  usually  are  of 
the  flabby,  semi-obese  type,  with  a  peculiar  pasty  appear- 
ance of  the  skin  of  the  exposed  parts.  Pigmentation  is 
occasionally  seen,  especially  in  cases  of  Graves'  disease 
with  thymus  involvement.  Incidentally,  the  records  of  the 
pathological  department  of  the  Johns  Hopkins  Hospital  in- 
dicate that  adrenal  atrophy  (and  presumably  adrenal  insuf- 
ficiency) is  common  in  cases  dying  from  status  thymo- 
lymphaticus.  Asthenia  is  a  usual  symptom  and  sometimes 
overshadows  the  other  subjective  symptoms,  and,  presum- 
ably, it  is  of  adrenal  origin.  Such  cases  often  suffer  from 
severe  metabolic  disorders  with  an  intoxication  which  is 
quite  probably  of  endocrine  origin. 

Quite  often  the  development  of  the  bones  is  disturbed, 
the  growth  of  the  extremities  being  stunted  and  a  condi- 
tion of  softening  quite  similar  to  osteomalacia  has  been 
attributed  to  thymus  disorder.  At  least  derangements  of 
the  calcium  metabolism  are  quite  usual  in  thymus  disease. 

The  circulatory  system  is  ineffective,  due  to  hypoplastic 
changes  in  the  heart  and  great  vessels.  As  a  result  of  these 
organic  changes  resistance  to  disease  is  low,  "the  constitu- 
tion is  poor"  and  trivial  things  may  produce  sudden  death. 


148  PRACTICAL  ORGANOTHERAPY 

In  young  individuals  the  abdomen  frequently  assumes  that 
type  known  as  "pot  belly"  and  there  is  important  clinical 
connection  between  thymus  disorder  and  rickets. 

Thymic  Asthma.  The  dyspnea  of  thymic  origin  has  some- 
what erroneously  acquired  the  name  "thymic  asthma." 
This  is  really  a  form  of  inspiratory  dyspnea  due  most  usu- 
ally to  tracheostenosis  caused  by  pressure  of  an  enlarged 
thymus.  It  is  only  one  of  a  series  of  symptoms  of  thymus 
hyperplasia  and  is  not  a  distinct  entity,  nor  is  it  amenable 
to  treatment  different  from  that  which  is  directed  at  the 
removal  of  the  thymus  or,  at  least,  the  pressure  that  it 
exerts  upon  the  structures  adjacent  to  it. 


SECTION  IV.    CHAPTER  10 
DISTURBANCES  OF  THE  PARATHYROID  GLANDS 


The  parathyroid  glands,  sometimes  called  "the  epithelial 
bodies,"  were  discovered  in  1880  but  their  significance  was 
not  hinted  at  until  1891  when  Gley,  of  Paris,  connected 
them  with  tetany.  Since  then  much  work  has  been  done 
to  establish  the  fact  that  the  parathyroids  are  definite  endo- 
crine organs. 

Parathyroid  Physiology.  The  diagnosis  of  parathyroid 
dysfunction  necessarily  presupposes  some  information  re- 
garding their  physiological  effect  upon  the  organism. 
Briefly,  it  may  be  said  that  while  complete  information 
about  the  parathyroid  functions  is  not  yet  available,  it  is 
evident  that  parathyroids  (1)  exert  a  control  upon  calcium 
metabolism  and  (2)  have  an  antitoxic  action,  the  chief 
purpose  of  which  is  the  destruction  of  "substances  which 
have  a  predilection  for  influencing  nervous  tissue."  The 
parathyroids  are  quite  independent  from  the  thyroid,  both 
in  origin,  histology  and  function.  This  does  not  prevent  a 
direct  or  indirect  relation  between  the  functions  of  the  two 
systems.  It  is  believed  that  parathyroid  insufficiency,  to 
some  extent,  checks  the  function  of  the  thyroid. 

Experimental  removal  of  the  parathyroids  usually  causes 
early  death,  preceded  by  a  neuro-muscular  symptom-com- 
plex described  under  the  name  of  tetany,  which  is  accom- 
panied by  a  marked  loss  of  calcium,  a  fact  which  has  been 
emphasized  clinically  by  the  excellent  results  of  MacCallum, 
of  New  York,  and  others  from  the  administration  of  cal- 


PARATHYROID  DISTURBANCES  149 

cium  salts  in  the  suppression  of  symptoms  due  to  parathy- 
roidectomy.  An  analysis  of  the  cases  reported  indicates 
that  the  intensity  of  post-operative  tetany  in  man  is  in 
inverse  proportion  to  the  amount  of  the  parathyroid  tissue 
that  may  be  left. 

The  Symptomatology  of  Tetany.  The  principal  symp- 
toms of  tetany,  whether  spontaneous  or  due  to  experi- 
mental parathyroid  ablation,  are  very  easily  diagnosed. 
Intermittent  tonic  spasms  of  the  voluntary  muscles  are  the 
rule,  especially  in  the  extremities.  The  flexor  groups  of 
muscles  are  almost  exclusively  involved.  Connected  with 
these  muscular  symptoms  are  headache,  asthenia,  varying 
degrees  of  rigidity  of  the  limbs,  twitching  and  severe  mus- 
cular pains.  The  contractions  begin  in  the  hands  and  later 
affect  the  feet,  causing  the  muscles  to  become  very  hard 
to  the  touch  and  to  oppose  decided  resistance  to  attempts 
to  relax  them.  Fibrillary  twitchings  are  sometimes  seen. 
These  experiences  occur  for  varying  lengths  of  time  from 
a  few  minutes  to  several  hours.  Usually  there  are  several 
attacks  in  the  day.  The  patient  is  restless  at  night,  and  in 
severe  cases,  while  consciousness  is  retained,  extreme  dysp- 
nea may  occur. 

Several  clinical  tests  are  available,  especially  in  the  differ- 
entiation of  mild  and  early  tetany.  The  test  suggested  by 
Erb  consists  of  the  discovery  of  a  marked  irritability  of 
the  motor  nerves,  especially  the  ulnar,  to  galvanic  stimuli. 
Very  small  amounts  of  electricity  cause  decided  contrac- 
tions, and  this  test  should  be  made  in  all  suspected  para- 
thyroid cases  because  of  its  sensitiveness  and  accuracy. 
Another  common  phenomenon,  first  noted  by  Trousseau,  con- 
sists of  the  production  of  a  tetanic  spasm  in  a  limb  following 
compression  of  its  main  nerve  trunks.  Further,  brief  mus- 
cular twitchings  in  the  face  can  be  elicited  in  patients  with 
tetany  by  gently  tapping  over  the  distribution  of  the  facial 
nerve  (Chvostek's  Sign).  All  these  tests,  of  course,  are 
made  between  the  spasms. 

Another  pathognomonic  finding  is  a  marked  increase  in 
guanidin  and  similar  substances  in  the  blood  and  urine,  and 
it  seems  from  the  work  of  Noel  Paton  of  Glasgow,  Koch  of 
Detroit,  and  others,  that  the  conclusion  is  warranted  that 
the  parathyroids  exert  a  destructive  catabolic  action  upon 
guanidin  and  its  precursors,  for  the  presence  of  these  sub- 
stances and  the  results  of  their  irritation  of  the  body  as  a 
whole,  and  the  nervous  system  especially,  are  very  marked. 
The  condition  known  as  spasmophilia,  an  abnormal  ten- 


150  PRACTICAL  ORGANOTHERAPY 

dency  to  convulsions  in  infants  and  children,  is  thought 
to  be  of  similar  origin  and  also  associated  with  undue  cal- 
cium depletion. 

There  is  such  a  thing  as  chronic  tetany,  in  which  occa- 
sional paroxysmal  tonic  contractions  of  muscle  groups  are 
found,  together  with  paresthesias  (usually  in  the  hands  and 
feet),  hyperexcitability  of  certain  nerves  and  trophic 
changes  in  the  teeth,  hair,  nails  and  bones. 

A  Hypoparathyroid  Syndrome.  Parathyroid  insufficiency 
does  not  necessarily  involve  a  picture  of  tetany  such  as  has 
been  given.  Hertz,  of  London,  reports  a  case  of  hypopara- 
thyroidism  where  extreme  depression,  nervousness  and 
restlessness  appeared  suddenly.  The  patient  was  continu- 
ally on  the  move  and  slept  very  little.  He  was  exceedingly 
tremulous,  had  difficulty  in  writing,  and  there  was  a  con- 
tinuous fibrillary  twitching  of  the  eyelids,  but  no  tetany. 
The  appearance  was  quite  similar  to  Graves's  disease,  ex- 
cept that  the  eyes  were  sunken  instead  of  prominent,  and  no 
thyroid  could  be  felt.  The  appetite  increased,  and  he  ate 
enormously  but  lost  weight.  He  had  some  difficulty  in  swal- 
lowing, due  to  irregular  spasmodic  contraction  of  the  eso- 
phagus, and  some  intestinal  pain,  probably  due  to  some  sim- 
ilar cause.  There  was  palpitation,  the  pulse  was  continually 
about  120,  and  his  face  and  neck  were  deeply  flushed.  In 
this  particular  case,  parathyroid  therapy  caused  an  entire 
cure,  and  it  is  proper  to  say  that  various  other  methods 
of  treatment  directed  previously  at  a  presumed  hyperthy- 
roidism  were  useless.  This  is  a  rare  case,  but  serves  to 
emphasize  the  parathyroid  symptoms. 

The  condition  of  hyperparathyroidism  does  not  seem  to 
have  been  given  consideration,  though  theoretically  it 
should  be  possible;  and  at  least  one  case  is  recorded  in  the 
literature. 

Paralysis  Agitans.  It  has  been  stated  that  various  dis- 
orders associated  with  muscular  tonicity  and  sympathetic 
irritability  may  be  connected  with  the  parathyroid  glands, 
and  the  most  thoroughly  studied  of  these  is  Parkinson's 
disease,  or  paralysis  agitans,  in  which  it  has  been  shown 
at  autopsy  that  the  parathyroids  are  quite  commonly  in- 
volved. Many  clinical  experiences  with  parathyroid  feeding 
indicate  a  possibility  of  controlling  the  various  well  known 
manifestations  of  this  disease.  It  is  stated  by  Berkeley, 
of  New  York,  that  while  parathyroid  extract  is  not  a  "cure" 
for  paralysis  agitans,  60  to  70  per  cent,  of  those  who  have 
given  this  remedy  a  fair  trial  for  at  least  three  to  six 


PANCREATIC  DYSFUNCTION  151 

months  have  been  greatly  benefited,*  and  in  such  patients 
the  progress  of  the  disease  has  been  arrested,  or  very  ma- 
terially retarded.  Based  upon  the  same  reasoning,  it  has 
been  thought  that  eclampsia  was  connected  with  parathy- 
roid insufficiency,  but  this  is  not  well  established.  Another 
point  of  clinical  interest  is  a  special  sensitiveness  to  neuro- 
stimulant  drugs,  such  as  strychnia,  which  has  been  linked 
up  with  hypoparathyroidism. 

To  sum  up,  the  parathyroids  evidently  are  intermittently 
concerned  in  destroying  certain  wastes  in  the  body,  and 
their  removal  or  insufficient  function  allows  these  products 
free  play,  with  the  resulting  muscular  and  nervous  irrita- 
tion. It  is  well  to  add  that  certain  digestive  disturbances 
in  children  (gastric  tetany)  may  cause  a  special  toxemia 
which  may  result  in  dysfunction  of  these  glands,  and  it  has 
been  noted  that  pregnancy  puts  an  extra  strain  on  the 
parathyroid  functions,  as  evidenced  by  the  occasional 
appearance  of  tetany  in  pregnant  women  and  the  common 
occurrence  of  tetany  in  partially  parathyroidectomized  preg- 
nant animals.  The  chief  clinical  conclusion  concerning  the 
parathyroids  is  to  connect  them  with  conditions  of  marked 
neuro-muscular  irritability. 


SECTION  IV.    CHAPTER  11 
PANCREATIC  ENDOCRINE  DYSFUNCTION 


The  pancreas  is  an  organ  with  both  an  internal  and  an 
external  secretion.  It  is  conclusively  established  that  the 
internal  secretion  is  a  product  of  the  islets  of  Langerhans, 
while  the  external  secretion  is  produced  in  the  cells  consti- 
tuting the  walls  of  the  acinous  portions  of  the  gland.  With- 
out a  doubt,  these  two  functions  are  related  to  one  another, 
and  conditions  likely  to  cause  pancreatic  indigestion  are 
equally  likely  to  cause  pancreatic  dyscrinism. 

Quite  the  most  important  disease  due  to  disturbed  inter- 
nal secretory  function  of  the  pancreas  is  diabetes  mellitus, 

*  Berkeley  gives  parathyroid  by  mouth  and  hypodermically.  Both 
are  advisable  for  the  first  stage  of  the  treatment;  later,  oral  ad- 
ministration is  advisable.  I  have  developed  a  formula,  No.  24,  Para- 
thyroid Co.  (Harrower),  in  which  an  average1  dose  of  parathyroid  is 
supplemented  by  two  known-to-synergize  products,  bile  salts  and 
spermin,  the  former  to  encourage  hepatic  activity  and  the  latter  to 
favor  cell  oxidation,  two  factors  involved  in  this  disease. 


152  PRACTICAL  ORGANOTHERAPY 

and  the  amount  of  work  done  upon  various  experimental 
aspects  of  this  subject  is  literally  enormous.  There  are 
actually  hundreds  of  papers  on  the  subject,  in  a  dozen  lan- 
guages; the  amount  of  experimental  work  upon  pancre- 
ectomized  animals  has  been  very  great,  and  without  taking 
much  time  or  space,  it  may  be  said  that  the  removal  of  the 
pancreas  brings  on  immediate  glycosuria,  which  may  be 
mitigated  or  controlled  by  the  successful  implantation  of 
pancreatic  tissue  and,  quite  often,  by  the  administration  of  a 
pancreas  preparation  rich  in  its  internal  secretory  product. 

The  Control  of  Sugar  Mobilization.  The  pancreas  pro- 
duces a  hormone,  occasionally  called  the  Langerhansian 
hormone,  which  von  Noorden,  of  Frankfort,  calls  "the  brake 
to  the  sugar  factory."  This  has  been  called  by  Lepine,  of 
Lyons,  an  anti-hormone,  for  indeed  the  chief  function  of 
the  pancreatic  internal  secretion  is  not  to  "arouse  or  set  in 
motion"  but  to  regulate  the  mobilization  of  sugar,  a  func- 
tion which  is  activated  by  the  adrenal  principle  to  which 
the  pancreatic  hormone  is  the  direct  antagonist.  As  a 
matter  of  fact,  pancreatic  diabetes,  so-called,  is  in  part  at 
least  a  condition  of  adrenal  sensitization  due  to  the  removal 
of  part  or  all  of  the  antagonizing  hormone  influences  of 
the  pancreas;  and  it  is  very  probable  that  the  initial  dis- 
turbances of  the  digestive  functions  of  this  gland  are  re- 
sponsible for  the  development  of  the  diabetes,  for  diabetes  is 
essentially  a  disease  of  those  with  overworked  digestive 
organs. 

In  the  experimental  work  upon  various  phases  of  the  pan- 
creas-diabetes question,  it  was  discovered  that  the  pancreas 
exerts  quite  a  marked  influence  upon  blood  pressure,  the 
general  tendency  being  to  reduce  it,  probably  by  its  capacity 
to  antagonize  abnormal  activity  upon  the  part  of  the  adrenal 
glands.  The  fact  that  the  blood  pressure  is  often  very  high 
in  diabetes  (pancreas  insufficiency)  tends  to  confirm  this. 
It  will  be  recalled  that  adrenin,  the  adrenal  medullary  prin- 
ciple, is  a  permanent  factor  in  the  maintenance  of  the  normal 
blood  pressure,  and  it  is  presumed  that  conditions  of  adrenal 
irritability  or  abnormal  activity  are  likely  to  be  associated 
with  an  increased  arterial  tension.  This  works  out  clini- 
cally very  nicely,  and  it  is  a  pleasure  to  be  able  to  say  that 
an  organotherapeutic  deduction  has  been  made  from  these 
principles  which  is  enabling  us  to  reduce  high  blood  pres- 
sure through  the  use  of  certain  glandular  combinations 
containing  desiccated  pancreatic  substance.  (See  chapter 
entitled  "Reducing  High  Blood  Pressure,"  Sec.  V,  Chap.  15.) 


LABORATORY   DIAGNOSTIC   MEASURES  153 

The  Pancreas  and  Immunity.  Still  another  very  impor- 
tant function  of  the  pancreas  concerns  the  resistance  of 
the  body  to  disease.  Evidently,  the  pancreas  exerts  a  well 
defined  control  over  the  immunizing  powers  of  the  body. 
Some  years  ago,  I  went  into  the  study  of  the  subject  quite 
carefully  and  wrote  a  paper  for  The  Practitioner  (London) , 
in  which  I  showed  that  pancreatic  dysfunction  should  be 
considered  in  every  case  of  serious  infection.  Attention 
was  called  to  the  fact  that  in  the  experimental  ablation  of 
the  pancreas  for  the  purpose  of  causing  artificial  diabetes 
in  dogs,  the  animals  died  from  sepsis  unless  a  small  abdom- 
inal graft  was  made  to  maintain  the  pancreas  endocrine 
control  and  thereby  tide  the  dog  over  the  serious  operation, 
after  which  the  graft  could  be  removed  later  from  the 
abdominal  wall.  Further  than  this,  it  is  clinically  well 
known  that  persons  with  diabetes  are  prone  to  aggravating 
infective  conditions,  as  boils,  carbuncles  and  gangrene. 
This  may  be  an  explanation  for  many  favorable  reports  in 
regard  to  the  use  of  pancreatic  preparations  in  tubercu- 
losis and  other  conditions  where  the  resistance-maintaining 
department  is  overworked  or  incompetent. 

So  far  as  is  known,  there  is  no  well  defined  condition  of 
pancreatic  hyperfunction,  although  such  a  condition  may  be 
physiologically  associated  with  hyperpituitarism  (acrome- 
galy),  in  which  it  is  known  that  there  is  a  disturbance  in 
the  capacity  of  the  organism  to  care  for  ingested  sugars. 


SECTION  IV.     CHAPTER  12 

LABORATORY  MEASURES  IN  DIAGNOSTIC 
ENDOCRINOLOGY 


The  majority  of  the  measures  which  enable  us  to  diagnose 
and  understand  endocrinopathies  are  largely  based  upon 
clinical  observations  rather  than  diagnostic  tests,  labora- 
tory or  otherwise.  Yet,  as  we  have  developed  our  knowl- 
edge of  the  subject,  various  procedures  of  a  laboratory 
nature  have  been  mentioned  as  helpful  and  deserve  consid- 
eration separately.  The  subject  has  been  considered  very 
fully  by  Rosenbloom,  of  Pittsburgh,  in  a  series  of  papers 
published  in  the  Interstate  Medical  Journal  (1918,  Nos. 
10,  11  and  12) ,  and  a  brief  consideration  of  the  most  prac- 
tical and  useful  of  these  tests,  with  a  passing  reference  to 


154  PRACTICAL  ORGANOTHERAPY 

those  which  cannot  well  be  made  use  of  in  ordinary  clinical 
practice,  will  constitute  this  chapter. 

Tests  for  Hyperthyroidism.  One  of  the  most  constant 
results  of  hyperthyroidism  is  a  condition  of  sympathetico- 
tonus  (see  also  Sec.  V,  Chap.  4),  in  which  it  is  found  that 
there  is  a  marked  sensitiveness  of  the  sympathetic  and 
vasomotor  nerve  endings,  so  that  very  slight  doses  of  the 
adrenal  medullary  principle  are  capable  of  causing  a  much 
more  rapid  and  marked  reaction  than  is  usually  the  case. 
Several  tests  are  based  upon  this  phenomenon. 

Loewi's  Mydriasis  Test.  In  his  study  of  experimental 
diabetes  in  animals  and  later  in  diabetes  mellitus,  Loewi 
discovered  that  the  installation  of  one  or  two  drops  of  ad- 
renalin chloride  solution  (1:1000)  into  the  conjunct! val  sac 
will  cause  a  pupillary  dilation  within  half  an  hour,  which 
reaches  its  maximum  within  an  hour  and  lasts  10  to  18 
hours.  Associated  with  it  is  a  marked  diminution  or  total 
absence  of  convergence  miosis,  though  the  light  reflex  is 
preserved.  This  reaction  is  quite  commonly  found  in  pan- 
creatic diabetes,  and  Loewi  also  suggested  that  this  test 
might  be  helpful  in  latent  hyperthyroidism  on  the  basis  that 
the  hormones  of  the  thyroid  and  adrenals  are  synergistic, 
both  stimulating  the  sympathetic;  hence  in  hyperthyroid- 
ism the  sympathetic  system  would  be  in  a  state  of  increased 
irritability,  and  the  dilator  nerves  to  the  iris  (governed 
by  the  sympathetic)  would  respond  abnormally  to  the  intro- 
duced adrenalin.  Quite  a  number  have  confirmed  the  value 
of  this  test,  but  some  state  that  it  is  not  invariably  useful ; 
at  least,  this  test  may  be  done  as  a  routine  with  possible 
advantage,  with  practically  no  trouble,  and  without  detri- 
ment. 

Goetsch's  Adrenalin  Test.  This  test  is  also  based  upon 
the  exaggerated  sensitiveness  to  adrenal  stimulation  which 
results  from  thyroid  irritability.  Eight  minims  of  1:1000 
solution  of  adrenalin  are  diluted  with  an  equal  quantity  of 
sterile  water  and  injected  hypodermically  into  the  arm.  Im- 
mediately there  is  formed  an  area  of  blanching  around  the 
point  of  injection,  and  about  the  margin  of  this  usually  a  red 
areola  gradually  shading  off  into  the  surrounding  tissue. 
In  about  half  an  hour  the  center  of  the  white  area  becomes 
bluish  gray  and  lavender,  and  at  the  end  of  about  one  and  a 
half  to  two  hours  the  red  areola  takes  on  the  bluish  or 
lavender  color,  while  that  in  the  center  disappears.  This 
lavender  areola  remains  for  about  four  hours  from  the  time 
of  injection  and  is  the  most  characteristic  part  of  the  test. 


LABORATORY  DIAGNOSTIC   MEASURES  155 

Accompanying  the  local  reaction  may  be  an  increase  in 
pulse  rate  with  palpitation  of  the  heart  and  a  temporary 
exaggeration  of  the  tremor  and  the  nervous  instability  in 
general. 

This  adrenalin  test  has  been  used  by  Goetsch  and  Nichol- 
son at  Trudeau  Sanatorium  (Amer.  Rev.  Tuberculosis, 
Apr.,  1919)  in  the  differentiation  of  early  tuberculosis  from 
hyperthyroidism.  If  the  patient,  following  the  injections 
as  indicated,  reacts  with  manifest  symptoms  of  hyperthy- 
roidism, Goetsch  believes  that  a  positive  diagnosis  of  this 
condition  is  justified  and  it  will  give  a  positive  reaction 
whether  associated  with  tuberculosis  or  not.  On  the  other 
hand,  tuberculosis  uncomplicated  by  hyperthyroidism  does 
not  react  positively  to  adrenalin,  and  they  feel  that  in  a 
considerable  number  of  borderline  cases  showing  symptoms 
more  or  less  characteristic  of  both  conditions,  they  can  now 
pick  out  those  with  hyperthyroidism  and  treat  them  accord- 
ingly. 

Calorimetry  or  Metabolimetry.  Perhaps  one  of  the  most 
valuable  aids  to  diagnosis  is  the  calorimeter,  the  apparatus 
by  which  the  basal  metabolism  is  estimated.  Basal  meta- 
abolism  is  the  minimal  heat  produced  by  an  individual.  By 
experimentation  the  average  heat  under  fixed,  given  cir- 
cumstances in  healthy  individuals  is  found  by  recourse  to 
this  instrument,  and  is  expressed  in  calories  per  square 
meter  of  body  surface. 

Some  use  a  tried  equation  made  from  the  known  height, 
weight,  sex,  and  age,  instead  of  the  square  surface  area 
of  the  body,  for  the  basis  of  this  test.  The  measurement  is 
made  when  the  body  is  at  muscular  rest,  but  awake,  12  to 
18  hours  after  the  ingestion  of  food.  Once  the  normal  met- 
abolic rate  is  fixed  for  an  individual  whose  sex,  height, 
weight,  and  age  are  taken  into  account,  the  calorimeter  is 
used  to  measure  the  rate  of  his  heat  production  (which 
coincides  with  the  amount  of  oxygen  he  consumes),  and  the 
result  is  compared  with  the  normal.  The  figures  express- 
ing the  rate  are  plus  or  minus,  according  to  the  finding, 
and  indicate  the  percentage  above  or  below  normal. 

As  with  the  common  clinical  thermometer,  some  diseases 
give  a  reading  above  normal  and  others  below,  so  here  the 
readings  are  marked  plus  or  minus. 

A  Clinical  Experience.  A  few  months  ago  a  young  lady, 
about  20  years  of  age,  who  had  recently  entered  my  employ, 
asked  for  advice,  knowing  only  that  she  had  a  slight  en- 
largement of  her  neck  and  that  she  was  more  nervous  than 


156  PRACTICAL  ORGANOTHERAPY 

formerly.  I  had  her  metabolic  rate  measured,  and  it  was 
plus  74 — an  unusually  high  figure,  by  the  way.  Her  pulse 
was  110-130  and  temperature  99  degrees. 

This  extremely  high  B.  M.  R.  could  not  exist  if  her  trouble 
had  been  neurasthenia,  the  disease  with  clinical  symp- 
toms that  sometimes  simulate  hyperthyroidism,  for  the 
basal  metabolism  is  always  near  normal  in  neurasthenia. 
Therefore,  considering  the  enlarged  thyroid,  the  conclu- 
sion was  quickly  reached  that  she  had  true  hyperthyroid- 
ism, and  that  her  real  trouble  was  hyperplastic  or 
exophthalmic  goitre,  in  this  case  the  exophthalmse  not  hav- 
ing yet  developed,  and  the  positive  high  percentage  of  find- 
ings showed  that  she  was  in  a  serious  condition.  She  was 
ordered  to  bed  without  delay  and  local  measures  as  well  as 
suitable  gland  feeding  were  promptly  ordered. 

An  additional  advantage  of  being  able  to  measure  the 
basal  metabolic  rate  is  found  during  the  time  the  patient 
is  under  treatment.  If  the  rate  is  measured  periodically, 
once  or  twice  a  month,  there  need  be  no  uncertainty  as  to 
the  rate  of  improvement  and  the  prognosis. 

Harrower's  Thyroid  Function  Test.  The  administration 
of  step-ladder  doses  of  thyroid  extract,  accompanied  by 
careful  study  of  the  pulse  prior  to,  during,  and  for  two  or 
more  days  after  the  use  of  this  extract  may  cause  a  ma- 
terial change  in  the  pulse-rate,  depending  upon  the  apathy 
or  sensitiveness  of  the  thyroid.  On  the  one  hand,  hyperthy- 
roidism may  be  easily  discovered  by  a  lack  of  any  reaction 
while,  on  the  other  hand,  the  pulse  chart  in  hyperthyroidism 
is  quite  typical.  (This  subject  is  discussed  more  fully  and 
explanatory  clinical  charts  are  reproduced  in  the  chapter 
entitled  "A  Method  of  Testing  Thyroid  Function,"  Chapter 
4  of  this  Section.) 

The  Respiratory  Quotient.  The  increased  metabolism  of 
this  disease  can  be  measured  by  studying  the  products 
eliminated  through  the  lungs  by  means  of  the  clinical  res- 
piration apparatus  of  Benedict,  or  other  similar  apparatus, 
developed  in  the  Nutrition  Laboratory  at  Boston.  This 
is  a  very  complicated  procedure,  involving  expensive  appa- 
ratus, which  enables  one  to  determine  the  oxygen  consump- 
tion, as  well  as  the  carbon  dioxide  production,  both  of  which 
are  considerably  increased  in  hyperthyroidism. 

Abderhalden's  Ferment  Test.  Lampe  and  others  believed 
that  the  blood  serum  of  patients  with  hyperthyroidism  con- 
tains ferments  which  are  specific  for  thyroid  tissue  by  fol- 
lowing the  Abderhalden  method,  and  this  indeed  may  be 


LABORATORY  DIAGNOSTIC  MEASURES  157 

true,  but  I  have  always  felt  that  the  technique  of  these 
sero-diagnostic  tests  was  too  complex  for  ordinary  physi- 
cians, and  even  too  much  the  subject  of  error  in  the  hands 
of  accomplished  technicians. 

Tests  for  Pituitary  Dysfunction.  Metabolism  and  the  res- 
piratory exchanges  have  been  studied  in  hyperpituitarism, 
and  in  the  somewhat  rare  uncomplicated  cases  there  is  no 
increase  as  in  hyperthyroidism  (q.v.),  but  unfortunately, 
it  is  not  usual  to  have  a  pure  pituitary  monoglandular  dis- 
turbance. 

Marie's  Artificial  Glycosuria  Test.  The  famous  French 
neurologist,  Pierre  Marie,  who  first  described  acromegaly, 
also  showed  that  it  is  often  accompanied  by  disturbances  in 
the  sugar  tolerance.  Based  upon  this,  it  is  possible  to  pro- 
duce a  "provocative  alimentary  glycosuria"  by  the  adminis- 
tration of  various  forms  of  sugar,  as  follows : 

1.  The  Sucrose  Test.    One  hundred   and   fifty  to  200 
grams  of  cane  sugar  syrup  are  given  to  the  subject  in  the 
morning  while  fasting.    The  urine  is  collected  every  hour 
and  tested  for  reduction  by  means  of  Fehling's  or  Bene- 
dict's solution.     A  reduction  makes  the  test  positive. 

2.  The  Glucose  Test.    The  patient  takes  in  the  morning 
before  breakfast,  on  an  empty  stomach,  150  grams  of  pure 
dextrin-free  glucose  dissolved  in  300  c.c.  of  water.     One 
can  allow  fifteen  minutes  in  which  to  drink  this  solution. 
The  urine  is  collected  every  hour  for  ten  hours  and  each 
specimen  tested  for  sugar.    The  patient  stays  on  a  milk 
diet  during  this  time.    The  presence  of  glucose  in  the  urine 
renders  the  test  positive  if  it  is  known  that  the  patient 
does  not  present  a  condition  of  spontaneous  glycosuria. 

3.  The  Levulose  Test.    One  hundred  grams  of  levulose 
are  given  in  the  morning  on  an  empty  stomach  and  the 
urine  examined  every  two  hours  for  the  presence  of  sugar. 
A  reduction  shows  presence  of  lessened  ability  to  use  this 
sugar. 

4.  The  Galactose  Test.    Thirty  grams  of  galactose  are 
given  to  the  patient  in  the  morning  on  an  empty  stomach 
and  the  urine  collected  every  two  hours  for  six  hours.    The 
presence  or  "absence  of  galactose  in  the  urine  is  determined 
by  Fehling's  or  Benedict's  solution. 

Sugar  Tolerance  Estimation.  In  hypopituitarism,  there 
is  a  very  marked  increase  in  sugar  tolerance;  and  while 
the  above  tests  are  carried  out  in  the  same  manner,  the 
patient  with  hypopituitarism  is  capable  of  tolerating  very 
much  larger  quantities  of  the  various  sugars,  and  twice  or 


158  PRACTICAL  ORGANOTHERAPY 

three  times  the  amounts  just  indicated  can  be  taken  with- 
out a  trace  of  glycosuria.  (See  Chapter  6,  Section  IV.) 

Tests  for  Adrenal  Function.  Adrenal  Sensitization.  The 
most  satisfactory  laboratory  test  consists  in  the  adminis- 
tration of  one  or  two  milligrams  of  adrenalin  chloride  (ap- 
proximately 18  minims  of  the  standard  1 :1000  solution  con- 
tain one  milligram)  by  hypodermic  injection.  In  cases  of 
adrenal  irritability,  or  hyperadrenia,  a  temporary  increase 
in  the  blood  sugar  begins  in  about  half  an  hour,  as  esti- 
mated by  any  one  of  the  several  methods  now  in  use,  and 
even  the  glycosuria  may  last  two  to  six  hours. 

The  Oculocardiac  Reflex.  In  1908,  an  Italian  physician 
named  Dignani  called  attention  to  a  noticeable  change  in 
the  pulse  rate  following  compression  of  the  eyeballs.  This 
reflex  has  been  found  to  be  exaggerated  in  epileptics,  and 
the  reaction  is  more  marked  the  more  frequent  the  seizures. 
This  reflex  seems  to  be  lost  very  early  in  tabes  and  may 
eventually  be  of  differential  diagnostic  value.  According 
to  Peterson,  of  Copenhagen,  this  reflex  deserves  great  at- 
tention from  a  medical,  as  well  as  a  neurologic  point  of  view, 
and  is  largely  valuable  in  the  study  of  paroxysmal  tachy- 
cardia, a  condition  evidently  due  to  disturbed  sympathetico- 
tonus,  a  condition  of  sympathetic  virility  commonly 
connected  with  dysadrenia.  According  to  Lian,  of  Paris, 
pressure  on  the  eyeballs  seems  to  be  the  most  potent  means 
at  our  command  to  influence  the  vagus  and  thus  indirectly 
control  heart  action,  and  he  recommends  the  use  of  this  re- 
flex test  as  a  therapeutic  means  of  arresting  paroxysmal 
tachycardia. 

Sergent's  White  Adrenal  Line.  Emile  Sergent,  of  Paris, 
has  described  this  vasomotor  phenomena  as  a  test  of  well- 
defined  hypoadrenia.  He  traces  a  geometrical  figure  on  the 
skin  of  the  abdomen — a  rectangle,  triangle,  or  cross — obvi- 
ating confusion  with  lines  caused  by  folds  of  the  skin,  etc. 
The  rounded  end  of  a  fountain  pen  is  advised  for  the  trac- 
ing. The  figure  should  be  made  by  a  simple  superficial 
stroking;  one  must  not  bear  down  or  scratch  the  abdomen. 
After  half  a  minute  a  pale  line  or  band  begins  to  be  noticed 
following  the  tracing.  Gradually  this  becomes  more  and 
more  distinct  and  white,  at  the  same  time  becoming  larger, 
so  that  eventually  the  line  exceeds  in  size  the  actual  area 
touched  by  the  pen.  This  white  line  attains  its  maximum 
clearness  in  the  course  of  about  one  minute,  and  persists 
for  one,  two,  or  even  three  minutes  before  being  grad- 
ually obliterated.  This  constitutes  the  reaction  in  well-de- 


LABORATORY  DIAGNOSTIC  MEASURES  159 

fined  cases  of  adrenal  insufficiency.  Sergent  considers  his 
so-called  "ligne  blanche  surrenale"  as  due  to  the  hypoten- 
sion brought  about  by  the  hypoadrenia.  It  is  known  that 
in  arterial  hypotension  there  is  present  a  peripheral  vaso- 
dilation  produced  by  a  slight  stimulation  of  the  skin. 
Vasoconstriction  replaces  the  vasodilatation  with  the  re- 
sulting white  line. 

Tests  for  Parathyroid  Dysfunction.  Erb's  Test.  The 
laboratory  test  for  hypoparathyroidism,  or  tetany,  sug- 
gested by  Erb  is  probably  the  most  dependable  and  uniform 
of  all  the  clinical  procedures  in  the  study  of  this  condition. 
Galvanic  stimuli  of  the  motor  nerves,  especially  the  ulnar 
nerve,  which  in  ordinary  individuals  are  inactive,  cause  de- 
cided contractions  in  tetany.  A  kathodal  opening  contrac- 
tion below  five  milliamperes  is  particularly  significant  and 
comparisons  with  normal  individuals  show  that  in  tetany 
contracture  follows  exceedingly  mild  stimuli. 

Tests  for  Pancreatic  Insufficiency  (Endocrine).  The  in- 
ternal secretory  function  of  the  pancreas  is  well  known  to 
antagonize  that  of  the  adrenals  and  at  the  same  time  is  inti- 
mately concerned  in  the  metabolism  of  carbohydrates.  De- 
ficient pancreatic  secretion  is  accompanied  by  glycosuria; 
hence  the  administration  of  sugar  will  aggravate  this.  This 
does  not  differentiate  between  hepatic  and  pancreatic  insuf- 
ficiency, but  in  the  former  instance,  the  administration  of 
desiccated  pancreas  substance  may  aggravate  the  glycosu- 
ria, while  the  use  of  desiccated  liver  substance  for  a  week  or 
more  would  cause  a  considerable  reduction  in  the  elimination 
of  sugar  in  the  case  that  the  hepatic  element  was  not  prom- 
inent. 

The  Cammidge  Test  ordinarily  is  considered  to  be  a  useful 
measure  for  discovering  whether  the  balance  between  the 
pancreatic  and  adrenal  secretion  is  disturbed  and  to  what 
degree.  It  is  a  complicated  laboratory  procedure,  the  dis- 
cussion of  which  is  unwarranted  here. 

Loewi's  Test  far  Pancreatic  Diabetes.  The  test  suggested 
by  Loewi  as  a  means  of  discovering  pancreatic  insufficiency 
in  diabetes  is  identical  with  that  already  mentioned  under 
the  heading  "hyperthyroidism"  and  consists  of  instilling 
one  or  two  drops  of  adrenalin  chloride  solution  into  one  eye. 
Garrod,  of  London,  has  found  this  test  positive  in  all  pan- 
creatic cases  but  rarely  in  other  cases.  Murray,  of  Man- 
chester, agrees  with  him  but  does  not  believe  it  is  as  useful 
in  hyperthyroidism  as  in  diabetes.  In  this  instance,  it  is 
presumed  that  the  dilation  occurs  because  of  the  mutual 


160  PRACTICAL  ORGANOTHERAPY 

stimulation  of  the  sympathetic  by  the  thyroid  and  adrenals, 
and  since  the  pancreas  definitely  antagonizes  the  adrenals 
in  normal  physiology,  the  removal  of  this  antagonism  would 
naturally  tend  to  an  adrenal  or  sympathetic  irritability  and 
hence  of  the  dilator  fibers  of  the  iris. 

Clinical  Test  with  Adrenalin.  Individuals  with  pancreatic 
diabetes  are  unusually  sensitive  to  adrenalin.  It  has  been 
noted  time  and  again  that  the  use  of  adrenalin  in  nose  and 
throat  surgery  in  diabetics,  for  instance,  causes  a  marked 
increase  in  the  average  sugar  output;  and  while  such  ex- 
periences amount  to  a  "therapeutic  test,"  it  is  not  advisable 
to  administer  adrenalin  products  when  the  adrenals  already 
are  so  thoroughly  uncontrolled  by  the  absence  of  the  nor- 
mal antagonism  of  the  pancreas  "antihormone." 

The  Thymus  Gland.  Differential  Blood  Count.  The  study 
of  the  relative  leucocyte  counts  in  individuals  with  a  persist- 
ent thymus  usually  shows  a  lymphocytosis,  the  small 
lymphocytes  being  increased  very  markedly.  Of  course, 
there  may  be  other  causes  for  lymphocytosis — tuberculosis, 
for  example — but  this  serves  as  one  small  factor  in  building 
up  the  picture. 

Fluoroscopy.  A  persistent  thymus  often  may  be  seen 
with  the  fluoroscopic  screen.  There  is  an  increased  shadow 
in  the  area  represented  by  the  triangle,  the  base  of  which 
is  just  below  the  suprasternal  notch  and  the  apex  of  which 
reaches  to  the  level  of  the  aortic  arch  or  approximately  the 
junctions  of  the  second  and  third  ribs  with  the  sternum. 
Often  the  shadow  is  especially  noticeable  on  either  side  of 
the  angles  formed  by  the  clavicles,  sternum  and  upper  ribs. 


SECTION  V. 

EVERY-DAY  ORGANOTHERAPY 


The  following  chapters  have  been  developed  from  cor- 
respondence, lectures  and  articles  on  the  practical  every- 
day problems  of  the  average  physician.  The  one  idea  run- 
ning through  them  all  is  to  emphasize  the  immense  possi- 
bilities of  organotherapy  in  routine  practice.  I  believe  I 
have  shown  that  there  is  an  endocrine  side — and  an  im- 
portant one — to  many  troubles  not  ordinarily  connected 
with  the  ductless  glands.  The  opportunities  to  attain  better 
results  in  general  practice  have  been  materially  broadened 
by  the  application  of  some  of  these  ideas  gathered  from 
many  scattered  sources,  worked  out  in  The  Harrower 
Laboratory  and  then  tested  in  "the  crucible  of  the  clinic" 
by  literally  thousands  of  my  colleagues. 

SECTION  V.    CHAPTER  I 

ASTHENIA:       THE      COMMONEST     SYMPTOM      IN 

MEDICINE 


Practically  all  individuals  with  overburdened  systems, 
that  is  to  say,  the  majority  of  the  cases  of  chronic  diseases 
which  are  so  very  common,  suffer  from  asthenia — loss  of 
strength.  In  fact,  asthenia  is  probably  the  commonest 
single  symptom  seen  in  medical  practice.  The  so-called 
"fatigue  syndrome" — in  which  the  patient  tires  too  easily 
and  too  early,  in  which  not  only  is  there  muscular  tiredness, 
but  initiative  is  lost  and  mental  capacity  is  dulled — is  one 
of  the  most  important  manifestations  in  chronic  toxemias. 

Cellular  Intoxication.  As  a  matter  of  fact,  asthenia  is 
really  another  name  for  cellular  intoxication — the  muscles 
after  work  are  tired  because  of  the  excess  of  intracellular 
wastes  which  have  been  produced  in  a  quantity  sufficient 
to  overburden  the  usual  means  of  elimination  as  well  as  all 
other  mechanisms  that  are  influenced  by  such  toxins.  Of 
course,  the  treatment  is  rest  or  refraining  from  all  work 
and  activity,  during  which  time  the  poisons  ordinarily  are 
11  161 


162  PRACTICAL  ORGANOTHERAPY 

carried  away  by  the  circulation  and  disposed  of.  Muscular 
asthenia  may  be  due  to  an  increased  production  of  these 
toxins  or  reduced  capacity  to  carry  them  off  as  manufac- 
tured. Both  causes  are  commonly  associated,  and  the  latter 
probably  is  the  more  important. 

A  Toxic  Vicious  Circle.  If  the  circulation  is  insufficient, 
i.  e.,  if  the  blood-pressure  is  low  and  the  "circulatory  pep" 
is  below  par  or,  in  other  words,  if  the  regulating  mechanism 
which  controls  circulation,  cardiac  efficiency  and  blood- 
pressure,  is  not  efficient,  asthenia  must  result  from  the 
accumulation  of  the  ordinary  amounts  of  cellular  wastes. 
This  would  be  aggravated  if  in  addition  to  this  there  were  an 
augmented  production  of  these  products.  It  also  happens 
that  poor  circulation  causes  poor  oxidation,  which  in  turn 
causes  an  accumulation  of  intracellular  wastes.  So  we  have 
a  vicious  circle,  the  one  condition  aggravating  the  other  and 
vice  versa. 

The  tendency  of  the  cell  is  to  die.  "Man  begins  to  die  as 
soon  as  he  is  born."  This  means  that  if  the  perpetual  pro- 
duction of  wastes  is  modified  ever  so  slightly  or  the  efficiency 
of  the  emunctories  fails,  there  is  going  to  be  trouble.  And 
the  initial  manifestation  of  this  kind  of  trouble  is  asthenia. 

What  is  the  earliest  symptom  of  incipient  tuberculosis? 
Asthenia.  What  is  the  chief  sign  of  the  other  most  com- 
mon toxemia — intestinal  stasis  and  alimentary  intoxication  ? 
Asthenia.  What  is  the  commonest  factor  in  any  infection, 
focal  or  otherwise,  or  infectious  disease  ?  Asthenia. 

Adrenal  Insufficiency.  What  underlies  the  asthenic  syn- 
drome? We  have  already  said  that  toxemia,  intracellular 
or  extracellular,  is  the  commonest  cause;  but  how  does  it 
bring  it  about  ?  In  the  answer  to  this  question  lies  the  basis 
of  a  new  conception  of  disease,  and  a  new,  or  at  least  an 
ignored,  method  of  treatment.  The  chief  cause  of  asthenia 
is  insufficiency  of  the  adrenal  glands.  Hypoadrenia  is  prob- 
ably the  most  common  endocrine  dysfunction.  It  deserves 
consideration  wherever  there  is  asthenia,  no  matter  whether 
it  is  called  neurasthenia,  psychasthenia,  myasthenia,  chem- 
asthenia,  cardiasthenia,  "neurocirculatory  asthenia,"  or  any 
of  the  numerous  other  names  given  to  various  clinical  mani- 
festations of  the  one  fundamental  underlying  trouble. 

"Why  do  you  connect  the  adrenal  glands  with  the  asthe- 
nias ?"  This  question  has  been  put  to  me  a  hundred  times 
or  more.  Here  is  the  answer  as  concisely  as  I  can  give  it : 
The  adrenal  glands  produce  an  internal  secretion  which  is 
known  to  exert  an  amazing  influence  upon  the  circulation. 


ASTHENIA  IN  MEDICINE  163 

Adrenin,  as  this  hormone  is  called,  is  a  predominant  factor 
in  the  maintenance  of  cellular  tone  and  especially  that  of  the 
unstriped  muscles  of  the  heart  and  intestines;  it  keeps  the 
blood-pressure  up ;  it  thus  favors  both  oxidation  and  detoxi- 
cation  (and  it  has  been  shown  that  adrenin  also  has  a  direct 
influence  upon  oxidation  besides  its  indirect  effect  through 
its  control  of  circulatory  efficiency) ;  by  its  musculo-tonic 
effect,  digestion  and  alimentary  tone  are  maintained,  hence 
hypoadrenia  favors  a  condition  of  atonicity  of  the  alimen- 
tary musculature  which,  in  turn,  causes  stasis  and  further 
toxemia — another  of  the  dread  vicious  circles.  This  hor- 
mone, adrenin,  has  been  shown  to  "control  the  sympathetic 
system,"  thereby  bringing  about  the  conditions  just  men- 
tioned as  well  as  other  subtle  chemical  regulations  which 
need  not  be  mentioned  in  this  brief  article. 

The  Sensitiveness  of  the  Adrenals.  Poisons  of  any  kind, 
in  the  most  minute  dosage,  have  an  immediate  effect  on 
these  most  sensitive  of  all  the  organs  of  the  body.  It  is  the 
business  of  the  adrenals  to  respond  to  these  influences,  for 
if  they  do  not,  the  increased  circulation  and  augmented 
oxidation,  which  become  essential  and  which  are  brought 
about  automatically  as  the  body's  greatest  means  of  pro- 
tection against  disease,  fail  to  take  care  of  the  toxemia. 
It  is  true  that  there  are  innumerable  forms  of  toxemia, 
some  toxins  which  are  the  usual  wastes  of  the  body  cells — 
some  which  are  unusual,  as  the  products  of  intestinal  putre- 
faction, some  which  we  ingest  wilfully  (as  coffee)  or  acci- 
dentally, some  which  are  produced  by  the  aberrant  activity 
of  certain  organs  and  especially  the  endocrine  glands  (for 
"too  much  of  a  good  thing  is  a  bad  thing"),  and,  finally, 
some  poisons  which  are  automatically  made  in  the  subtle 
chemical  changes  which  occur  in  shock,  emotional  storm 
or  the  various  mental  states  like  fear,  rage,  worry,  and  so 
forth.  In  other  words,  practically  all  forms  of  stimuli  of 
the  nature  mentioned  stimulate  the  adrenals.  Too  often  the 
persistence  of  these  stimuli  is  more  than  these  little  glands 
can  bear,  and  they  play  out.  We  have  as  a  result  a  func- 
tional hypoadrenia,  and  the  first  symptom  is  asthenia. 

It  should  be  unnecessary  to  give  clinical  proof;  it  is  so 
extremely  common.  We  have  already  mentioned  the  asthe- 
nia of  the  earliest  stages  of  tuberculosis,  before  the  cough 
and  sputum  materialize.  We  know  that  "post-influenzal 
asthenia"  is  indeed  a  most  uniform  result  of  the  toxemia 
of  this  scourge.  During  the  influenza  epidemics  the  un- 
usually severe  toxemia  resulted  in  serious  depletion  of  the 


164  PRACTICAL  ORGANOTHERAPY 

adrenals  in  many  thousands  of  cases,  and  brought  attention 
very  forcibly  to  the  importance  of  these  glands  as  main- 
tainers  of  the  tonicity  of  the  body.  Not  merely  influenza, 
but  all  acute  infectious  diseases  and  the  accompanying  tox- 
emias, as  well  as  all  chronic  foci  of  infection,  are  common 
factors  in  overstimulating  the  adrenal  glands.  //  these 
little  glands  were  not  stimulated,  the  body's  defenses  against 
these  conditions  would  not  be  initiated  properly,  and  death 
would  ensue.  We  know  that  following  pneumonia,  typhoid, 
malaria  or  any  acute,  infectious  disease,  hypoadrenia  is  the 
rule.  We  know  th*at  an  emotional  shock — bad  news,  an 
accident,  an  unusual  and  strenuous  mental  impression  as 
seeing  an  accident  or  death — will  cause  a  "let-down"  that 
is  nothing  but  a  more  or  less  serious  manifestation  of  adre- 
nal asthenia.  In  some  unusually  susceptible  individuals— 
those,  for  instance,  whose  adrenals  have  had  much  to  put 
up  with — far  less  important  stimuli,  as  an  unexpected  noise 
or  slight  "tiff"  at  home,  cause  an  asthenia  that  is  as  well 
defined  as  it  is  usual. 

"Endocrinasthenia."  From  a  clinical  standpoint,  it  is  im- 
possible to  have  a  combination  of  conditions  such  as  the  va- 
rious asthenias  already  mentioned  without  endocrinasthenia 
— the  natural  result  of  functional  insufficiency  of  the  glands 
of  internal  secretion,  or  hypocrinism.  The  adrenals  are  too 
intimate  with  the  other  endocrine  glands  to  be  affected 
alone.  In  fact,  not  only  is  this  endocrinasthenia  a  very  real 
clinical  entity,  but  it  is  the  underlying  cause  of  the  other 
asthenias,  for  it  is  impossible  for  an  individual  to  be  "all  run 
down"  and  to  be  suffering  from  asthenia  without  both  the 
cause  and  the  effect  exerting  their  influence  upon  the  sen- 
sitive endocrine  organs.  In  other  words,  when  the  body  is 
tired  the  endocrine  glands  are  also  tired.  When  the  circula- 
tion is  slowed  the  endocrine  glands  are  affected  with  the 
rest  of  the  body,  and  when  the  vital  service  of  hormone  pro- 
duction by  the  endocrine  system  is  reduced  ever  so  little, 
we  have  asthenia  as  one  of  the  immediate  results,  whether 
the  toxemia  is  a  prominent  factor  or  not,  and  the  greater 
this  endocrinasthenia  the  worse  do  the  other  forms  of 
asthenia  become.  We  have  another  serious  vicious  circle. 

The  big  thing  about  functional  hypoadrenia  is  the  possi- 
bility of  modifying  its  effects  by  supporting  the  endocrine 
glands.  Thousands  of  run-down,  tired-out,  asthenic  indi- 
viduals— many  of  them  labeled  "neurasthenics,"  many 
called  "convalescents,"  many  in  whom  the  asthenia  is 
ignored  because  it  is  submerged  by  some  more  obvious  con- 


ASTHENIA  IN  MEDICINE  165 

dition,  as  rheumatism,  ovarian  dysfunction,  a  focal  infec- 
tion or  some  mechanical  difficulty  in  the  abdomen — have  as 
their  most  prominent  and  their  most  responsive  symptom 
asthenia,  resulting  from  a  plain  case  of  adrenal  insufficiency. 

The  Symptoms  of  Adrenal  Insufficiency.  What  are  the 
usual  symptoms  besides  asthenia?  Fatigue  is  the  principal 
result,  and  it  may  be  of  a  most  severe  character.  The  pa- 
tients are  tired  out  and  unable  to  accomplish  the  usual  men- 
tal or  physical  work.  They  have  an  aggravated  degree  of 
muscular  fatigue  which  extends  to  the  involuntary  muscles, 
causing  heart  weakness  (very  commonly  these  cases  are 
classed  as  "myocarditis"  when  in  reality  there  is  no  real 
structural  change  in  the  heart  muscle  at  the  time) ,  the 
vessel  walls  lose  their  tonicity,  and  as  a  result  there  is  a 
condition  of  low  blood-pressure  which,  in  turn,  causes 
cold  hands  and  feet  and  other  evidences  of  circulatory 
insufficiency. 

The  muscles  of  the  alimentary  canal  are  equally  atonic, 
and  as  a  result  there  is  constipation,  indigestion  and  the 
well-known  intestinal  stasis  and,  naturally,  malnutrition, 
Toss  of  weight,  anemia,  and  so  on.  Parenthetically  it  may 
be  stated  that  the  toxemia  from  intestinal  stasis  is  just  as 
much  a  cause  of  adrenal  stimulation  as  that  which  results 
from  any  other  poisoning,  and  consequently  the  adrenals 
are  still  further  depleted,  with  still  more  atonicity.  Thus 
a  vicious  circle  is  produced. 

In  fact,  the  Addisonian  syndrome  which  results  from 
severe  organic  adrenal  disease  is  merely  an  incurable,  aggra- 
vated form  of  the  very  same  trouble,  the  difference  being 
merely  one  of  degree.  Does  this  fit  in  with  several  cases  on 
your  list  now?  Yes,  indeed.  Then  why  not  support  the 
adrenals,  in  addition  to  prescribing  elimination,  rest  and 
other  measures  to  remove  underlying  causative  elements? 
Adrenal  support  is  a  great  advance  in  every-day  practice. 
It  works ;  and  the  results  are  sometimes  wonderful.  It  may 
be  given  practical  application  with  the  greatest  facility  by 
prescribing  Adreno-Spermin  Co.  (Harrower) ,  a  plurigland- 
ular  formula  which  I  devised,  and  which  combines  adrenal 
support  from  a  suitable  dose  of  adrenal  substance  plus  "the 
dynamogenic  hormone"  spermin  (from  the  interstitial  cells 
of  Leydig  in  the  testes) ,  phosphorus  in  the  form  of  calcium 
glycerophosphate,  supplemented  by  a  very  small  dose  of 
thyroid  extract. 

The  obvious  and  rational  measures  for  the  treatment  of 
all  forms  of  asthenia  are  (a)  rest,  (b)  the  removal  of  as 


166  PRACTICAL  ORGANOTHERAPY 

many  as  possible  of  the  aggravating  factors  such  as  toxins, 
both  those  produced  in  the  body  (alimentary)  and  those 
taken  into  the  body,  wittingly  or  unwittingly;  and  circum- 
stances calculated  to  stimulate  emotional  elements,  like 
worry,  fear,  pain,  etc.;  (c)  the  natural  stimulation  of  the 
dynamogenic  factors  in  the  body,  e.  g.,  the  glands  of  internal 
secretion,  by  means  of  organotherapy  (on  the  well-known 
principle  of  homostimulation  represented  in  the  Adreno- 
Spermin  formula  just  referred  to);  and  (d),  finally,  suit- 
able nutrition,  both  as  regards  food,  water,  and  especially 
the  mineral  elements  of  the  organism.  All  of  these  physi- 
ological measures  should  be  recommended  simultaneously; 
and  many  hundreds  of  experiences  with  this  procedure, 
more  especially  when  "adrenal  support"  is  given  as  sug- 
gested, convince  one  that  this  endocrine  encouragement 
"increases  the  pep"  or,  in  other  words,  antagonizes  asthenia. 
In  this  connection,  it  may  be  remarked  that  in  addition  to 
bringing  about  a  noticeable  change  in  the  tendency  to  mus- 
cular fatigability  or  tiredness,  it  is  possible  to  get  a  very 
fair  idea  of  the  benefit  in  figures,  for  such  treatment  in- 
creases the  lowered  systolic  blood  pressure,  increases  the 
subnormal  temperature  and  increases  the  elimination  of 
urinary  wastes,  especially  urea. 

The  Essentials  of  Adrenal  Support.  The  matter  of  giving 
consideration  to  the  adrenal  or  endocrine  factor  in  asthenia 
is  important  in  the  extreme,  and  if  organotherapy  is  rational 
in  Addison's  disease  it  is  doubly  so  in  these  functional  con- 
ditions since  they  are  far  more  likely  to  respond  to  this 
physiological  support.  For  convenience  some  of  the  essen- 
tial facts  are  arranged  below  in  semi-tabular  form  so  that 
they  may  be  the  more  readily  appreciated  and  applied : 

PHYSIOLOGY.    The  Adrenal  Hormone  (adrenin) 

(1)  Regulates  the  sympathetic  system; 

(2)  Maintains  muscular  tone ; 

(3)  Supports  cardiac  action; 

(4)  Keeps  the  blood  pressure  up; 

(5)  Facilitates  oxidation,  and  thus 

(6)  Antagonizes  fatigue. 
Adrenal  Function  is  deranged  by 

(1)  Toxemia  (acute  and  chronic) 

Food  poisons  and  drugs;  intestinal  stasis;  focal 
infections;  infectious  diseases. 

(2)  Emotional  Stimuli 

Fear  and  worry ;  pain ;  shock. 


ADRENALS  IN  TUBERCULOSIS  167 

(3)     Dyshormonism 

Such  as  ovarian  disease,  thyroidism,  etc. 
The  adrenals  cooperate  with  the  other  endocrine  glands, 
especially  the  thyroid  and  gonads. 

DIAGNOSIS.  Adrenal  Depletion  (hypoadrenia)  may  be 
diagnosed  by  noting  two  or  more  of  the  following: 

(1)  Asthenia,  "the  fatigue  syndrome,"  with  muscular 
and  psychic  inefficiency  or  "lack  of  pep ;" 

(2)  Hypotension  with  cardiasthenia,  cold  extremities 
and  internal   venous   stasis — the  so-called   "hypo- 
sphyxia"  of  Martinet; 

(3)  Hypothermia — Subnormal  temperature; 

(4)  Malnutrition    due    to    the    poor    oxidation    and 
elimination ; 

(5)  Acidosis  in  greater  or  less  degree  is  also  naturally 
present. 

THERAPEUTICS.  Adrenal  support  by  suitable  organo- 
therapy properly  should  accompany  detoxicative  and 
hygienic  measures. 

Adrenal  Substance  homostimulates  the  adrenals  and 
replaces,  in  part,  the  deficient  adrenin. 

Spermin  from  the  Leydig  cells  of  the  gonads  stimulates 
muscular  tone  (dynamogenic)  and  cell  chemistry. 

Thyroid  Extract  encourages  endocrine  action  generally, 
and  in  hypoadrenia  there  is  always  hypothyroidism. 

Calcium  Glycerophosphate  is  not  only  a  useful  mineral  but 
is  considered  to  have  an  especially  beneficial  effect  in  neu- 
rasthenic conditions. 

The  above  are  suitably  combined  in  an  effective  pluri- 
glandular  formula,  Adreno-Spermin  Co.  (Harroiver) , 
which  supports  the  adrenals,  antagonizes  asthenia  and 
raises  lowered  blood-pressure. 


SECTION  V.    CHAPTER  2 
ADRENAL  SUPPORT   IN  TUBERCULOSIS 


In  a  recent  issue  of  The  Organotherapeutic  Review  a  cor- 
respondent, the  Superintendent  of  a  sanatorium  in  Indiana, 
wrote  the  query  department  as  follows:  "I  would  be  very 
pleased  to  receive  your  suggestions  for  the  use  of  organo- 


168  PRACTICAL  ORGANOTHERAPY 

therapy  in  tuberculosis.  The  asthma,  the  low  blood-pres- 
sure, the  chronic  continuous  poisoning,  the  low  Arneth 
blood  count  surely  indicate  a  condition  needing  special  boost- 
ing and  more  than  we  have  been  in  the  habit  of  giving." 

The  syndrome  mentioned  by  this  writer  is,  to  my  mind, 
essentially  of  endocrine  origin.  Practically  every  one  of 
the  symptoms  enumerated  is  related  to  disturbed  adrenal 
function;  and  I  believe  that  the  adrenal  element  in  the 
tuberculous  is  as  early,  constant  and  important  as  any  other 
factor,  whether  cause  or  effect.  Perhaps  the  truth  of  this 
statement  can  be  verified  best  by  testing  in  "the  crucible  of 
the  clinic."  Clinical  results  are  the  only  factors  that  count 
for  very  much  in  medicine.  We  can  theorize  all  day,  but 
this  does  not  cure  our  patient.  It  may  be  all  right  to  the- 
orize; but  it  is  far  more  practical  and  helpful  to  establish 
the  reasonableness  of  some  suggestion  that  may  be  new  to 
us  than  to  pass  it  up  without  thought. 

A  great  many  items  have  been  published,  especially  in 
French,  on  the  advantages  of  various  organotherapeutic 
procedures  in  tuberculosis.  Some  of  them  are  sound ;  some 
are  questionable.  We  still  have  the  tuberculosis,  and  all 
these  statements  have  not  controlled  this  plague.  I  am  not 
pessimistic,  however,  for  some  of  these  reports  are  really 
"getting  us  somewhere,"  especially  the  splendid  contribu- 
tions of  Emile  Sergent,  of  Paris,  whose  original  interest  in 
"I'insuffisance  surrenale" — hypoadrenia — centered  in  his 
studies  of  the  tuberculous,  and  from  which  has  been  devel- 
oped much  of  real  value  in  endocrinology.  Sergent  is  an 
accepted  authority;  he  has  proved  his  points.  His  "Col- 
lected Papers  on  Adrenal  Disorders — 1898-1920"  is  a  won- 
derful book,  though  it  is  in  French,  of  course.  Suffice  it  to 
say  that  Sergent  has  shown  us  that  adrenal  insufficiency  is 
the  rule  in  many  cases  of  tuberculosis.  In  fact,  the  first 
suspicious  manifestations  of  tuberculosis  are  of  adrenal 
origin,  for  asthenia  or  "the  tiredness  of  incipient  phthisis" 
is  the  essential  initial  symptom,  to  be  followed  shortly  by 
the  subnormal  morning  temperature — and  all  this  before 
there  may  be  any  cough  or  sputum. 

Sergent's  Views.  I  have  translated  several  paragraphs 
from  the  above  book,  and  submit  them  here  in  support  of 
my  own  attitude: 

"Adrenal  opotherapy  finds  its  principal  usefulness  in  the 
course  of  tuberculosis  in  three  conditions.  It  is  well  known 
that  the  signs  of  adrenal  insufficiency  are  by  no  means  rare 
in  tuberculosis,  and,  of  course,  these  are  the  first  indication^ 


ADRENALS  IN  TUBERCULOSIS  169 

for  organotherapy;  but  one  ought  to  have  special  recourse 
to  this  method  when  the  cardiotonic  and  vasoconstrictor 
influence  is  desirable.  In  this  connection  I  will  show  you 
that  it  constitutes  an  excellent  adjuvant  to  the  treatment 
known  as  remineralization. 

"Your  attention  has  already  been  called  to  the  Addisonian 
syndrome  and  also  to  the  usual  syndromes  o£  typical  adre- 
nal insufficiency,  or  the  formes  frustes  of  Addison's  dis- 
ease. In  these  cases  the  patients  show  predominating 
lesions  in  their  adrenal  glands,  and  the  clinical  picture 
which  develops,  is  a  typical  one.  We  will  not  now  occupy 
ourselves  with  these  well-defined  cases.  I  wish  to  describe 
to  you  those  cases  in  which  attention  is  directed  away  from 
the  actual  pulmonary  lesions,  but  in  whom,  however,  the 
careful  examination  reveals  signs  of  an  insufficient  function- 
ing of  the  adrenal  glands  with  or  without  changes  in  the 
skin  in  the  nature  of  melanoderma. 

"The  adrenal  glands  of  these  individuals  do  not  present 
at  autopsy  characteristic  lesions  of  tuberculosis,  but  they 
are  altered,  nevertheless.  Babes  has  found  sclerosis  and 
cellular  alterations  quite  commonly.  Lucien  and  Parisot 
have  emphasized  the  frequent  diminution  of  physiologic 
activity  of  the  adrenals  in  the  tuberculous.  Boinet  has  de- 
scribed a  condition  in  advanced  cases,  under  the  term  'Addi- 
sonism,'  a  combination  of  clinical  symptoms,  indicating  a 
certain  degree  of  adrenal  insufficiency.  Laffitte  and  Mon- 
cany  have  reported  similar  facts  and  have  used  the  term 
'petite  insuffisance  surrenale,'  or  minor  hypoadrenia. 
Sezary  has  found  a  sclerotic  adrenal  condition  in  many 
tuberculous  persons  in  whom  marked  loss  of  weight  and 
extreme  muscular  atrophy  were  contrasted  with  the  slight 
extent  of  the  actual  pulmonary  lesions.  I  have  myself 
observed  and  published  many  analogous  cases  which  I  have 
classed  in  two  categories:  Those  positively  tuberculous 
individuals,  who  are  tired  rather  than  weak,  with  low  ten- 
sion, in  whom  one  can  discover  a  number  of  discrete  pig- 
mentary areas  on  the  skin  and  on  the  mucosa  of  the  mouth. 
The  others,  on  the  contrary,  who  do  not  show  the  slightest 
degree  of  pigmentation,  but  in  whom  the  extreme  asthenia 
and  loss  of  weight  are  striking.  If  you  examine  them  more 
carefully  you  will  see  that  this  nutritional  change  is  not 
solely  due  to  a  disappearance  of  fat,  but  that  there  is  also 
a  considerable  loss  in  muscular  tissue.  Auscultation  de- 
velops signs  of  a  quite  well  localized  tuberculous  process, 
and  in  no  case  is  it  comparable  to  the  real  gravity  of  the 


170  PRACTICAL  ORGANOTHERAPY 

general  condition.  One  hates  to  conclude,  under  such  cir- 
cumstances, that  there  is  a  special  form  of  tuberculous  in- 
fection of  a  hypertoxic  character,  and -is  really  led  to  be- 
lieve that  the  accompanying  adrenal  insufficiency  may  be 
the  cause. 

"You  will  find  also  a  large  diagnostic  element  in  the  re- 
sults of  organotherapy.  I  have  observed  a  certain  number 
of  individuals  in  whom  I  have,  in  this  fashion,  proved  abso- 
lutely the  adrenal  origin  of  these  findings.  These  facts 
have  a  very  great  practical  importance  because  you  can,  if 
you  care  to,  institute  a  useful  therapeusis.  You  will  not 
use  adrenalin,  but  the  total  extract  of  the  adrenal  gland.  I 
have  been  in  the  habit  of  using  ordinary  relatively  small 
doses  representing  perhaps  thirty  centigrams  of  the  desic- 
cated powder.  If  this  produces  neither  vertigo  nor  head- 
ache, I  rapidly  increase  the  dose  to  sixty  or  even  ninety 
centigrams  a  day.  This  intensive  medication  ought  not  to 
be  continued  for  a  long  time.  It  is  preferable  to  push  the 
dose  for  eight  or  ten  days,  separated  by  intervals  of  an  equal 
length. 

"Of  course  our  investigations  should  not  be  limited  to 
these  matters.  You  should  always  study  the  arterial  ten- 
sion and  will  know  when  to  stop  if  you  cause  a  relatively  too 
rapid  increase  in  the  tension.  You  will  push  the  treatment, 
on  the  contrary,  if  the  tension  falls.  You  will  often  be  very 
pleased  to  find  that  a  low  tension  has  been  increased 
very  decidedly  and  to  see  a  progressive  attenuation  of  the 
usual  symptomatology  of  general  adrenal  insufficiency,  and 
particularly  the  asthenia  and  malnutrition. 

"Dp  I  believe  that  this  has  a  direct  action  upon  the  tuber- 
culosis itself  ?  Evidently  it  does  not ;  at  least,  not  directly, 
but  in  raising  the  general  response  of  the  individual  and  in 
putting  him  into  a  better  general  state,  you  are  favoring 
the  fight  and  raising  the  efficacy  of  the  body's  powers  of 
controlling  the  actual  tuberculous  infection.  The  good 
effects  of  this  practical  method  have  been  confirmed  by 
Renon,  Gourand,  Paillard  and  Lereboullet.  It  goes  without 
saying  that  the  usual  routine  treatment  of  tuberculosis 
ought  to  be  instituted  at  the  same  time  as  the  adrenal  sup- 
port." 

Adrenal  Insufficiency  Predisposes  to  Tuberculosis.  It  can- 
not be  denied  that  every  person  with  tuberculosis,  whether 
of  the  lungs  or  elsewhere,  irrespective  of  the  stage  of  the 
infection,  has  a  pair  of  unduly  burdened  adrenal  glands 
which  are  expected  to  regulate  many  vital  sympathetic 


ADRENALS  IN  TUBERCULOSIS  171 

functions  and  which  are  subject  to  the  baneful  influence  of 
those  very  disorders  of  metabolism  which  predispose  to  the 
infection.  Poor  oxidation,  malelimination,  bad  nutrition 
affect  the  adrenals  before  the  invasion  of  the  bacilli.  The 
adrenal  factor  discussed  in  the  previous  chapter  almost 
invariably  antedates  the  actual  infective  process.  Did  you 
ever  think  how  common  a  predisposing  cause  to  tuberculosis 
is  a  cold,  la  grippe  or  the  "flu?"  Have  you  found  out  that 
hypoadrenia  is  quite  the  biggest  factor  in  influenza,  pneu- 
monia or  even  a  bad  cold?  That  it  is  due  to  the  bacterial 
and  other  toxemia  and  is  the  reason  for  the  uniformly  low 
arterial  tension,  the  severe  asthenia  and  the  invariable 
hyposphyxia?  And,  by  the  way,  this  circulatory  syndrome 
described  by  Prof.  Alfred  Martinet  is  extremely  common  in 
tuberculosis.  "Hyposphyxia"  is  a  condition  of  poor  circula- 
tion, with  cold  extremities,  internal  venous  stasis  (abdom- 
inal and  pulmonary),  cardiac  weakness  and  hypotension. 
These  individuals  are  suffering  from  hypoadrenia ;  the  adre- 
nals are  supposed  to  maintain  circulatory  and  cardiac  tone, 
and,  being  depleted,  the  circulatory  cause  of  tuberculosis 
obtains. 

Speaking  of  the  involvement  of  the  adrenal  functions  in 
influenza,  pneumonia  and  other  acute  infectious  diseases, 
and  my  view  that  adrenal  support  was  in  order  as  a  part  of 
the  treatment,  I  laid  down  in  the  February  (1919)  issue  of 
the  Review  the  following  points : 

1.  The  blood  pressure  is  low  following  influenza. 

2.  The  severe  asthenia  or  "let-down"  which  character- 
izes this  disease,  and  especially  convalescence  from  it,  is  a 
part  of  a  syndrome  so  nearly  identified  with  hypoadrenia 
that  it  is  not  unfair  to  call  it  by  that  name. 

3.  The  circulatory  insufficiency  that  accompanies  influ- 
enza— the    hypotension,    subnormal    temperature,    venous 
stasis  and  cardiac  asthenia  or  "hyposphyxia"  (Martinet)  — 
is  the  chief  predisposing  cause  of  the  serious  and  all-too- 
common   sequel,  pneumonia.      (Poor  circulatory  efficiency 
with   stasis   certainly   does   not    favor   resistance   to   the 
pneumococci  or  any  other  germs.) 

4.  Attempts  to  make  these  facts  of  service  establish  as 
fully  as  sphygmomanometry  the  rationale  of  this  concep- 
tion.    In  other  words,  the  success  which  follows  adrenal 
support  emphasizes  the  importance  of  the  adrenal  depletion. 

Why  should  not  adrenal  support  be  rational  in  tubercu- 
losis as  it  has  been  proved  time  and  again  in  influenza?  It 
is,  and  the  raised  blood-pressure  is  not  the  only  obvious 


172  PRACTICAL  ORGANOTHERAPY 

benefit,  either.  There  is  a  production  of  "pep"  quite  similar 
to  that  we  have  found  from  strychnia  or  other  time-worn 
tonics,  but  it  just  happened  that  this  fatigue-antagonism  is 
not  due  to  stimulation  but  to  a  more  nearly  normal  physi- 
ology (on  the  part  of  the  adrenal  system)  resulting  from 
the  homostimulation  (referred  to  in  Section  II),  which 
means  better  circulation,  better  oxidation  and  a  diminution 
of  causes  rather  that  effects.  Is  not  this  logical? 

The  Toxic  Element  in  Tuberculosis.  Again  consider  the 
matter  from  another  standpoint.  It  is  certain  that  every 
sufferer  from  tuberculosis  is  toxic  r  not  merely  from  focal 
poisoning,  but  from  alimentary  intoxication.  The  toxemia 
antedates  the  infection ;  and  when  the  infection  has  become 
obvious  the  toxemia  is  so  much  greater.  Toxemia  is  the 
greatest  single  cause  of  adrenal  stimulation.  It  must  be 
thus,  for  it  is  a  large  part  of  the  functions  of  these  little 
glands  to  react  to  the  slightest  poisoning — irrespective  of 
its  origin — so  that  the  circulatory  and  detoxicating  mechan- 
ism which  they  control  may  be  stimulated  in  order  to  con- 
trol of  toxemia  and  its  effects.  Overstimulation  produces 
hyperadrenia,  the  most  usual  findings  of  which  are  sym- 
pathetic irritability,  dry  mouth  and  throat,  and  the  occa- 
sional "digestive  crises"  which  come  on  without  apparent 
cause  and  pass  off  very  soon.  It  should  be  stated  here  that 
a  condition  of  well-defined  hyperadrenia  is  rare,  merely  be- 
cause the  adrenal  principle — adrenin — is  oxidized  with  un- 
usual ease  and  rapidity  (that  is  why  adrenalin  therapy  is 
less  efficacious  in  prolonged  hypoadrenias)  and,  too,  because 
the  adrenals  cannot  stand  prolonged  overstimulation,  and 
become  depleted — knocked  out ! 

So  adrenal  insufficiency  is  indeed  common  in  tuberculosis. 
In  my  estimation  there  never  was  a  case  in  which  the  adre- 
nals were  not  involved,  though  I  do  not  want  it  understood 
that  I  am  referring  to  actual  cellular  pathology  or  adrenal 
tuberculosis.  I  repeat :  Tuberculosis  is  a  disease  in  which 
the  adrenal  functions  are  seriously  impaired.  The  chronic 
continuous  poisoning  referred  to  by  this  correspondent  is 
exerting  its  inexorable  influence  upon  the  adrenals  with  the 
result  that  muscular  fatigue  is  the  rule,  oxidation  is  below 
par  (study  the  urinary  solids  and  be  surprised  at  the  uni- 
formly poor  elimination),  the  temperature  is  subnormal  at 
times,  the  blood  pressure  is  110  or  less — very  ordinarily 
less,  depending  upon  the  length  of  time  that  the  adrenals 
have  had  to  stand  the  toxemic  hammering — and  the  patient 
is  "all  run  down."  The  syndrome  of  hypoadrenia  is  com- 


ADRENALS  IN  TUBERCULOSIS  173 

plete.  We  have  a  "functional  Addison's  disease,"  which 
may  and  occasionally  does  develop  into  the  real  Addisonian 
syndrome,  which  consists  of  the  aforementioned  symptoms 
in  an  aggravated  degree,  as  well  as  the  typical  pigmentation 
and  Sergent's  "white  adrenal  line." 

The  Rationale  of  Adrenal  Support.  Now  if  this  sounds 
sensible,  why  should  we  not,  in  addition  to  our  other  efforts 
in  the  line  of  hygiene  or  medication,  attempt  to  support  the 
overworked  adrenals  ?  Candidly,  I  do  not  believe  that  adre- 
nal support  will  make  any  direct  and  material  difference  to 
the  extent  of  the  infection,  nor  that  it  will  reduce  the  viru- 
lence of  the  invading  organisms,  whether  the  B.  tuberculosis 
or  the  invariably  associated  pyogenic  cocci.  But  I  most 
assuredly  believe  in  adrenal  support,  whether  as  a  part  of 
the  treatment  of  tuberculosis  or  any  other  condition  in 
which  the  adrenals  are  depleted.  If  some  of  my  colleagues 
would  only  get  the  idea  that  I  do  not  believe  in  organother- 
apy as  the  treatment  of  this,  that,  or  any  other  disease,  and 
that  the  study  of  endocrine  function  is  or  should  be  a  part 
of  the  complete  study  of  a  given  case,  they  would  be  less 
liable  to  mislead  themselves — and  others. 

Is  tuberculin  a  good  thing?  Most  of  us  will  say  "Yes." 
Shall  we  ignore  it,  then?  No;  we  will  judiciously  add  it  to 
other  indicated  measures.  Why  not  the  same  attitude  to 
the  important  subject  under  discussion?  One  remedy  or 
procedure  may  be  ever  so  good,  but  it  does  not  necessarily 
follow  that  it  is,  therefore,  the  treatment.  We  will  continue 
to  use  suitable  diet  and  hygiene,  tuberculin  may  help  a  lot, 
so  will  proper  intestinal  antisepsis  (I  am  convinced  that 
benefit  from  guaiacol,  thiocol,  calcreose  or  other  similar 
remedies  is  more  decidedly  alimentary  than  pulmonary)  and 
to  all  this  add  a  careful  consideration  of  the  adrenal  func- 
tions. If  they  are  really  depleted  and  the  patient  shows  the 
usual  syndrome  already  mentioned,  let  us  encourage  adrenal 
physiology  by  homostimulative  organotherapy  in  the  same 
way  we  have  been  doing  this  for  years  in  other  conditions 
of  hypoadrenia.  This  fits  in  splendidly  with  our  other 
measures  in  the  treatment  of  tuberculosis  and  supplements 
it — let  me  emphasize — not  supplants  it! 

I  have  hesitated  to  say  very  much  in  my  literature  about 
my  formula,  Adreno-Spermin  Co.  (Harrower),  in  tubercu- 
losis, because  I  felt  that  I  would  be  promptly  misunderstood 
and  branded  as  attempting  to  capitalize  the  attitude  com- 
mon to  the  tuberculous  and  to  many  of  their  medical 
advisers  and  be  criticized  for  boosting  this  formula  as  a 


174  PRACTICAL  ORGANOTHERAPY 

remedy  for  this  particular  disease.  It  is  not;  but  it  tends 
to  raise  a  lowered  blood-pressure — by  actual  sphygmomano- 
metry,  it  increases  oxidation — by  the  urinary  findings,  it 
certainly  favors  the  cellular  chemistry,  and  hence  nutrition, 
and  does  so  by  supporting  the  adrenals.  And  if  the  adrenals 
are  depleted,  no  matter  whether  the  name  of  the  accom- 
panying disease  is  Addison's  disease,  neurasthenia,  post- 
influenzal  asthenia,  tuberculosis  or  whatnot,  to  support 
them  and  favor  the  betterment  of  their  all-important  func- 
tions is  a  sound  therapeutic  procedure. 

Possible  By-Effects.  A  point  has  come  up  a  number  of 
times  in  regard  to  possible  by-effects  of  this  method.  For 
instance,  one  physician  inquires:  "Do  you  feel  that  it  is 
safe  to  give  the  Adreno-Spermin  Co.  to  a  patient  with 
advanced  tuberculosis  who  has  previously  had  hemorrhages 
but  whose  pulmonary  condition  has  been  quiescent  for  a 
year,  the  blood  pressure  being  within  the  normal  limits? 
Would  you  expect  this  preparation  to  give  relief  from  the 
neuro-muscular  asthenia  in  this  case  ?  Do  you  consider  that 
tuberculosis  per  se  is  a  contraindication  to  any  one  of  the 
glandular  products?" 

The  Adreno-Spermin  formula  is  active  for  three  reasons: 
It  supports  adrenal  function  and  thereby  raises  sympathetic 
tone,  including  abnormally  low  blood-pressure,  etc.  It  has  a 
dynamic  effect,  especially  on  muscle,  due  to  both  the  adrenal 
content  and  the  spermin,  which  is  believed  to  be  the  best 
musculo-tonic  remedy  of  its  kind.  It  contains  neuro-tonic 
elements  (lecithin  and  a  generous  dose  of  glycerophosphate 
of  calcium)  and  hence  has  some  effect  upon  nutrition, 
especially  where  the  accepted  cellular  influence  of  phos- 
phorus is  likely  to  be  helpful. 

I  do  not  believe  that  the  adrenal  stimulation  brought 
about  by  the  small  and  gradually  active  doses  of  adrenal 
substance  would  favor  hemorrhage  in  a  case  such  as  is  men- 
tioned, though  pituitrin  or  adrenalin  injections  might  be 
contraindicated  for  their  decided  and  temporary  pressor 
influence.  The  Adreno-Spermin  formula  has  no  immediate 
or  active  effect — it  is  very  gradual  in  its  action  and  there- 
fore less  likely  to  have  contraindications.  Remember  that 
organotherapy  is  really  a  form  of  endocrine  education.  The 
homostimulant  effects  of  gland  extracts  favor  the  reestab- 
lishment  of  normal  endocrine  function  in  the  glands  which 
correspond  to  those  from  which  the  extracts  are  made. 
This  explains  a  large  part  of  the  benefits  obtainable  from 
organotherapy. 


THYROID  IN  TUBERCULOSIS  175 

Such  treatment  supports  the  adrenals  and  gradually 
raises  an  abnormally  low  tension ;  but  in  a  normal  individual 
it  makes  little  or  no  difference  to  the  average  blood-pressure. 

Tuberculosis  is  not  a  contraindication  to  organotherapy. 
In  fact,  with  the  exceptions  just  mentioned — the  rapidly 
acting  pressor  principles — organotherapy  may  help  much  as 
has  been  suggested.  Again,  if  a  tuberculous  girl  has  an 
ovarian  dystrophy,  to  mitigate  it  by  suitable  organotherapy 
surely  is  proper;  just  as  an  individual  with  hepato-biliary 
insufficiency  who  happens  to  have  tuberculosis  will  benefit 
from  suitable  hepato-biliary  stimulation  as  with  the  use  of 
Hepato-Splenic  Co.  (Harrow  er) ,  which,  by  the  way,  seems 
to  have  a  good  effect  on  malnutrition  with  alimentary  lazi- 
ness and  has  been  used  with  benefit  in  many  cases  of 
tuberculosis  in  which  the  digestive  element  was  prominent. 

The  subject  is  a  large  one,  requiring  more  space  than  can 
be  given  to  it  here.  The  great  point  to  remember  is  this : 
If  adrenal  function  is  depleted  and  ignored,  our  best  ther- 
apeutic efforts  will  be  less  effective  because  of  the  extreme 
importance  to  resistance  of  the  circulatory,  sympathetic 
and  metabolic  function  maintained  by  these  glands.  The 
tuberculous  individual  has  a  hard  enough  fight — any 
assistance  that  we  can  render  is  worth  while,  especially 
when  it  is  so  necessary,  so  generally  overlooked,  and  so 
comparatively  easily  accomplished  by  means  of  a  suitable 
organotherapeutic  support  added  to  the  other  indicated 
treatment. 


SECTION  V.    CHAPTERS 
THE   THYROID   FACTOR   IN  TUBERCULOSIS 


That  there  are  other  endocrine  aspects  to  tuberculosis  is 
not  denied.  We  have  seen  in  the  previous  chapter  that 
many  clinical  facts  make  out  a  good  case  for  an  adrenal 
aspect  to  this  common  infection.  Now  I  purpose  to  reprint 
a  communication  of  my  own,  published  in  American  Med- 
icine (December,  1920),  which  explains  somethings  regard- 
ing the  thyroid  aspect  of  this  disease : 

"Because  of  my  special  interest  in  endocrinology,  and  be- 
cause I  live  in  sunny  Southern  California,  I  am  frequently 
confronted  with  problems  which  connect  the  glands  of  inter- 
nal secretion  with  tuberculosis.  It  has  occurred  to  me  to 


176  PRACTICAL  ORGANOTHERAPY 

set  down  a  few  ideas  on  this  subject  as  I  judge  from  a  num- 
ber of  comments  that  the  medical  profession  as  a  whole  may 
not  be  as  appreciative  of  the  importance  of  the  endocrine 
aspect  of  tuberculosis  as  it  deserves. 

"As  is  well  known,  the  thyroid  gland  is  a  very  important 
factor  in  the  control  of  the  defences  of  the  body.  Aside 
from  being  the  most  important  regulator  of  the  chemistry 
of  the  cell,  it  is  also  proved  by  Sajous  and  others  to  be  a 
factor  in  the  immunity  response  of  the  body  to  infections. 
Consequently  any  condition  as  definitely  a  toxemia  and  an 
infection  as  tuberculosis  is  known  to  be,  necessarily  must 
influence  the  thyroid  gland,  and  through  it  also  those  func- 
tions over  which  it  presides. 

"Let  us  first  consider  for  a  moment  the  influence  of 
toxemia.  The  thyroid  gland  is  probably  the  greatest  single 
factor  in  the  detoxicating  mechanism  of  the  body.  It  is  also 
equally  concerned  in  the  stimulation  of  the  other  features 
of  the  cell  chemistry.  In  other  words,  intracellular  oxidiza- 
tion depends  upon  the  thyroid  hormone.  If  toxemia  lays  an 
extra  burden  upon  the  thyroid,  one  would  expect  to  find  a 
well  defined  thyroid  aspect  in  tuberculosis,  and  we  do  very 
routinely.  Both  thyroid  irritability,  and  hypothyroidism, 
may  result  from  the  conditions  which,  combined,  we  call 
'tuberculosis/  You  note  that  I  refer  to  'conditions'  rather 
than  to  a  single  entry,  for  tuberculosis  is  never  a  single 
problem.  It  always  involves  a  number  of  factors  among 
which  the  actual  infection  by  the  tubercle  bacillus  is  really 
but  a  small  part.  As  a  matter  of  fact,  the  associated  pus 
germs  usually  produce  a  greater  degree  of  toxemia  and 
endocrine  disturbance  than  the  actual  B.  tuberculosis  itself, 
and  all  students  of  the  subject  admit  that  a  pure  tubercu- 
losis infection  is  a  rare  thing. 

"No  matter  whether  the  trouble  is  purely  tuberculosis  or 
whether  it  is  a  mixed  infection,  the  thyroid  gland  is  bound 
to  be  influenced,  not  merely  by  the  bacterial  products  them- 
selves, but  by  those  other  wastes  which  result  from  the 
symptom-complex  which  is  associated  with  the  infection. 
I  am  referring  particularly  to  the  asthenic  condition  which 
is  pathognomonic  of  tuberculosis,  a  condition  which,  by  the 
way,  involves  the  adrenal  glands  very  definitely  and  to 
which  I  have  referred  previously  in  other  communications, 
and  which  makes  serious  changes  in  the  cellular  chemistry. 

"If  the  thyroid  mechanism  of  an  individual  is  in  good 
order  the  stimulation  from  these  toxins  associated  with 
tuberculosis  causes  thyroid  irritability,  as  a  result  of 


THYROID  IN  TUBERCULOSIS  177 

which  there  are  well  defined  symptoms  akin  to  hyper- 
thyroidism. In  fact,  hyperthyroidism  occasionally  has  been 
found  as  a  part  of  the  syndrome  of  tuberculosis,  and  Emil 
Goetsch  has  called  particular  attention  to  the  value  of  his 
method  of  differentiating  true  hyperthyroidism  and  the 
quite  similar  condition  which  is  associated  more  definitely 
with  tuberculosis.  I  do  not  believe,  however,  when  the 
symptoms  which  simulate  hyperthyroidism  are  found  in 
tuberculosis  that  they  are  due  to  anything  else  than  an 
irritation  of  the  endocrine  glands  as  a  whole,  and  the  thyroid 
and  adrenal  glands  together  in  particular. 

"If  the  stimuli  to  thyroid  are  not  sudden  and  severe,  i.  e., 
if  they  are  of  a  long-standing,  persistent,  nagging  variety, 
there  is  not  so  likely  to  be  the  strenuous  reaction  of  the 
thyroid  to  these  influences  and  in  course  of  time  the  patients 
begin  to  discover  that  more  is  wrong  than  they  have  been 
accustomed  to.  Their  asthenia,  heretofore  comparatively 
bearable,  becomes  very  much  more  aggravated;  they  are 
much  more  toxic  and  their  appearance  may  approximate 
quite  closely  that  of  the  patient  with  myxedema.  They 
have  a  dull  headache  in  the  morning  on  rising;  their  joints 
crack  and  sometimes  are  quite  painful;  their  skin  is  rough 
and  dry,  and  the  appendages  of  the  skin — the  hair  and  nails 
— are  brittle  and  have  lost  their  usual  pliability.  Constipa- 
tion is  the  rule  and  digestive  conditions  are  very  much 
aggravated.  In  other  words,  they  begin  to  find  added  to  all 
the  usual  troubles  of  the  sufferer  from  tuberculosis  another 
series  which  are  dependent  upon  hypothyroidism.  Here  the 
thyroid  gland  has  been  stimulated  gradually  and  persist- 
ently until  it  has  been  played  out  and  as  a  result  of  these 
long  continued  stimuli  we  have  a  condition  of  thyroid  ineffi- 
ciency which  varies  in  degree  and  consequently  in  the 
character  and  extent  of  its  effects  upon  the  body. 

"To  me  the  condition  of  infiltration  which  is  so  usually 
present  in  hypothyroidism  is  worth  a  little  more  extended 
consideration  than  has  seemed  to  be  the  case  in  the  litera- 
ture on  tuberculosis.  It  will  be  recalled  that  Hertoghe,  of 
Antwerp,  has  emphasized  the  importance  of  the  infiltration 
which  always  accompanies  hypothyroidism  and  is  serious 
in  proportion  to  the  degree  of  thyroid  inactivity.  Since  the 
thyroid  hormone  stimulates  the  cell  chemistry,  a  lack  of  this 
hormonic  stimulus  spells  slowed  cellular  activity  with  an 
accumulated  toxemia  which  disturbs  the  chemical  changes 
going  on  in  the  cell  structure.  The  retained  wastes  increase 
the  density  or  concentration  of  the  cell  fluids  and  they  draw 

12 


178  PRACTICAL  ORGANOTHERAPY 

to  themselves,  from  the  blood  and  tissue  fluids,  enough 
plasma  to  equalize  the  intracellular  osmotic  tension  with 
that  of  the  blood.  A  puffiness  and  swelling  ensue,  due  to 
the  natural  physical  changes  expected  under  such  circum- 
stances. This  is  the  so-called  'thyroid  infiltration,'  and  it  is 
indeed  an  important  element  in  many  a  disorder. 

"Naturally  this  infiltration  influences  circulation  very 
definitely  and  consequently  the  resistance  of  the  body  to 
disease,  which  depends  in  a  very  large  measure  upon  a  satis- 
factory circulation,  is  lowered.  The  lung  is  not  immune  to 
the  influences  of  the  thyroid  and  this  condition  of  infiltra- 
tion— which  decidedly  affects  the  skin,  the  alimentary  canal, 
the  larger  organs  of  the  body  and,  in  fact,  the  whole  organ- 
ism— must  cause  some  changes  in  the  lung,  as  a  result  of 
which  the  capillary  circulation  is  mechanically  lessened  and 
the  extremely  important  chemical  exchanges  of  oxygen  and 
carbon  dioxide  by  the  blood  are  lessened.  So  in  addition  to 
the  general  lack  of  cellular  oxidization  due  to  the  thyroid 
insufficiency  there  is  an  equally  important  deficient  chem- 
istry due  to  the  slowed  gaseous  exchange.  Naturally  this 
must  have  a  serious  influence  upon  the  general  conditions  in 
tuberculosis  and  besides  this  it  must  also  exert  a  local  influ- 
ence upon  those  responses  which  the  body  makes  in  the 
lungs  to  the  invasion  by  the  organism  involved. 

"It  will  be  seen,  then,  that  both  hyperthyroidism  and 
hypothyroidism  are  likely  to  be  found  in  tuberculosis;  the 
former  occasionally  and  most  frequently  in  the  early  cases 
and  in  the  most  healthy  individuals;  and  the  latter  more 
commonly  in  the  cases  of  longer  standing  and  in  individuals 
in  whom  toxemia  from  various  sources  has  lessened  mate- 
rially the  body's  capacity  to  respond  in  the  usual  manner  in 
which  the  body  resists  disease. 

"I  have  made  a  number  of  observations  on  quite  a  few 
cases  and  have  come  to  the  conclusion  that  hypothy- 
roidism is  probably  nine  times  as  frequent  as  hyperthy- 
roidism in  the  average  run  of  cases  of  chronic  pulmonary 
tuberculosis,  and  consequently  no  further  consideration 
will  be  given  in  this  paper  to  the  condition  of  hyperthyroid- 
ism as  it  may  influence  the  treatment  of  tuberculosis  save 
to  say  that  since  hyperthyroidism  is  practically  always  due 
to  toxemia,  no  matter  whether  it  is  focal  or  otherwise,  every 
effort  should  be  made  to  detoxicate  and  to  sedate  the 
thyroid  and  the  sympathetic  system  by  means  of  suitably 
fitted  together  organotherapeutic  products.  Parenthet- 
ically, I  may  remark  that  pancreas  gland  is  an  excellent 


THYROID  IN  TUBERCULOSIS  179 

sympathetic  sedative.  In  addition  to  this,  adrenal  sub- 
stance sometimes  is  very  efficient  in  overcoming  the 
asthenia  resulting  from  hyperthyroidism,  and  a  combination 
of  these  originally  evolved  by  Crotti  (known  as  Pancreas 
Co. — Harrower),  has  been  used  successfully  by  me  for  a 
long  time  in  hyperthyroidism.  It  is  just  as  valuable  in 
tuberculosis  where  a  hyperthyroidism  may  be  prominent. 

"The  conditions  of  hypothyroidism,  on  the  other  hand,  are 
so  commonly  present  in  tuberculosis  that  it  seems  to  me  a 
very  unfortunate  thing  that  the  profession  so  uniformly 
ignores  the  endocrine  glands  and  confines  its  efforts 
largely  to  the  hygienic,  tuberculin  and  dietetic  treatment  of 
tuberculosis.  All  these  measures  are  good  and  worthy  to 
be  commended,  but  when  there  is  a  well  defined  endocrine 
aspect  to  any  case,  no  matter  whether  it  may  be  tuberculosis 
or  not,  every  effort  to  treat  other  conditions  which  involves 
the  ignoring  of  the  underlying  endocrine  bases,  is  going  to 
fail  in  proportion  as  it  ignores  these  vital  elements. 

"In  other  words,  the  tuberculosis  patient  should  always 
be  studied  from  the  standpoint  of  the  endocrine  glands  and 
particularly  the  thyroid.  By  means  of  my  Thyroid  Function 
Test  it  is  very  easy  to  determine  whether  an  individual's 
thyroid  function  is  apathetic  or  unusually  sensitive.  The 
use  of  this  test  in  a  number  of  cases  has  shown  that  the 
thyroid  gland  does  not  respond  to  the  step-ladder  dosage 
of  thyroid  which  constitutes  the  test,  and  when  the  obvious 
treatment  is  applied — support  of  the  played-out  thyro- 
adrenal  system — noticeable  changes  for  the  better  fre- 
quently have  followed.  I  do  not  mean  that  to  encourage  a 
depleted  thyroid  or  to  increase  cellular  chemistry  neces- 
sarily is  a  cure  for  tuberculosis — far  from  it ;  but  to  ignore 
the  support  of  these  glands  when  depleted,  no  matter  what 
other  treatment  may  be  given,  is  to  pass  by  a  very  rational 
and  useful  measure. 

"The  application  of  this  idea  is  neither  empirical  nor 
unscientific.  It  is  logical  to  presume  that  a  gland  with 
functions  as  important  as  those  of  the  thyroid  which  are 
involved  so  definitely  in  every  case  of  infection  and  toxemia 
necessarily  must  eventually  become  overworked,  and  when 
the  endocrine  glands  are  overworked  we  have  hypocrinism; 
and  in  this  instance,  hypothyroidism.  We  admit  that 
thyroid  therapy  is  a  useful  measure  in  obvious  cases  of 
hypothyroidism  as  cretinism  or  myxedema,  but  we  have 
been  frequently  in  the  habit  of  overlooking  the  minor  forms* 
They  are  just  as  important,  or  even  more  so. 


180  PRACTICAL  ORGANOTHERAPY 

"If  the  thyro-adrenal  system  is  depleted  and  we  support 
it  with  Adreno-Spermin  Co.  (Harrower) ,  we  increase  oxidi- 
zation, we  stimulate  cellular  chemistry,  we  favor  the 
immunizing  response  of  the  body  and  nutrition,  and  in  every 
way  encourage  those  very  factors  upon  which  we  depend  for 
the  body's  response  to  such  other  treatment  as  may  be 
.given  simultaneously." 


SECTION  V.    CHAPTER  4 

PLURIGLANDULAR  THERAPY  IN  THE  FUNCTIONAL 

NEUROSES 


A  neurosis  is  said  to  be  a  disorder  of  the  nervous  system 
not  dependable  on  any  discoverable  lesion ;  and  since  there  is 
no  obvious  organic  change,  it  is  natural  to  presume  that 
practically  all  neuroses  are  of  the  functional  type.  There 
are  a  number  of  neuroses  that  enter  into  and  complicate  the 
work  of  the  general  practitioner  in  the  most  disconcerting 
way  and  involve  the  treatment  of  many  cases  very  decidedly. 
Perhaps  the  most  common  of  these  is  known  as  the  "fatigue 
neurosis,"  a  neurotic  condition  due  to  nerve  tire,  otherwise 
known  as  neurasthenia  or  psychasthenia.  The  subject  of 
asthenia  already  has  been  given  considerable  attention  in 
this  book,  and  I  hope  it  has  been  shown  to  be  connected 
with  adrenal  dysfunction;  for  neurasthenia  is  likely  to  be 
profitably  considered  from  the  standpoint  of  the  internal 
secretory  organs,  and  particularly  the  adrenals. 

Butler's  Notions  about  Functional  Diseases.  An  interest- 
ing statement  by  the  late  Dr.  George  F.  Butler  (Am.  Jour. 
Clin.  Med.,  1918,  p.  679)  may  be  quoted  here:  "The  pecu- 
liar characteristic  thing  about  the  physiologic  pathology  of 
all  the  functional  nervous  diseases  is  that  the  neurons  them- 
selves are  not  primarily  at  fault.  They  are  merely  scape- 
goats. They  bear  the  brunt  of  some  other  morbid  condition, 
and  the  nervous  disturbance  is  an  end-result.  A  quality 
that  is  common  to  them  all  is  a  certain  irritability  and 
spasm,  due  not  to  a  positive  exaggeration  of  function,  but 
to  a  sort  of  negative  disability.  The  neurons  may  be  likened 
to  a  workman  fretting  because  of  a  lack  or  poor  quality  of 
tools ;  and  one  might  as  well  expect  to  get  good  work  out  of 
the  workman  in  such  a  plight  by  drugging  him  into  stupe- 
faction as  to  expect  to  remedy  the  neuroses  with  narcotics. 


FUNCTIONAL  NEUROSES  181 

They  merely  add  one  form  of  toxicosis  to  another.  The 
essential  morbid  state  in  all  of  these  diseases  is  that  of  a 
nervous  revenue  which  is  not  adequate  to  the  ordinary  de- 
mands of  living.  The  rational  principle  of  treatment  is  to 
bring  the  expenditure  as  far  as  possible  within  the  income, 
either  by  decreasing  the  former  or  by  increasing  the  latter, 
or  both.  In  one  sense  they  are  the  most  obstinate  of  all 
nervous  ailments,  for,  as  intimated,  these  patients  usually 
inherit  their  neurotic  tendencies,  and  one  has  to  do  with  the 
complex  ramifications  of  biological  stresses  and  strains. 
They  are  physical  ne'er-do-wells,  just  as  some  persons  are 
financially  shiftless.  It  is  almost  as  impossible  to  make 
solid,  prosperous  individuals  out  of  either  type  as  to  change 
the  leopard's  spots.  The  most  that  can  be  done,  with  the 
physical  as  with  the  economic  ne'er-do-well,  is  to  educate 
and  help  them  to  live  within  their  modest  income." 

Sympatheticotonus  and  Vagotonus.  In  the  last  few  years, 
two  new  terms  have  crept  into  current  medical  literature — 
Sympatheticotonus  (sympathicotonus)  and  vagotonus.  As 
the  names  indicate,  the  former  is  a  condition  of  tonicity  re- 
sulting from  overaction  of  the  sympathetic  nervous  system, 
whereas,  on  the  other  hand,  vagotonus  is  the  result  of  irri- 
tability of  the  vagus  or  pneumogastric  nerve.  It  happens 
that  the  functions  of  the  vagus  are  antagonistic  to  those  of 
the  sympathetic;  hence,  vagotonus  is  virtually  the  opposite 
of  Sympatheticotonus.  Both  of  these  conditions  are  allied 
to  neurasthenia  and  unquestionably  are  connected  very 
closely  with  disturbances  of  the  glands  of  internal  secretion. 
In  the  former  instance — Sympatheticotonus — there  is  an 
unusual  irritability  of  the  adrenal  glands  with  hypersensi- 
tiveness  of  the  sympathetic  and  general  overwork  of  all  the 
organs  involved  and  controlled  by  this  mechanism.  Natur- 
ally, Sympatheticotonus  will  last  either  until  it  is  controlled 
by  proper  therapeutics  or  until  the  organs  that  are  played 
upon  by  the  sympathetic  impulses  "give  up,"  in  which  case 
the  opposite  manifestation,  or  vagotonus,  will  obtain. 

In  my  estimation  the  whole  subject  of  the  diagnosis  and 
treatment  of  these  intangible  nervous  manifestations  may 
be  considered  with  greater  satisfaction  from  the  standpoint 
of  the  endocrine  glands.  For  instance,  we  know  that  the 
adrenal  system  is  intimate  in  its  control  of  the  sympathetic 
nervous  system ;  hence  adrenal  irritability  which  will  cause 
Sympatheticotonus  will  also  be  the  underlying  cause  of 
vagotonus,  provided  this  irritation  is  allowed  to  go  on  far 
enough  or  until  the  adrenals  can  stand  it  no  longer  and 


182  PRACTICAL  ORGANOTHERAPY 

"play  out."  Of  course,  those  factors  which  influence  the 
adrenal  glands  and,  for  that  matter,  the  other  glands  of 
internal  secretion,  must  be  considered  in  our  study  of  either 
an  increase  or  deficiency  of  sympathetic  tone.  For  example, 
it  is  well  known  that  neuroses  of  this  character  result  from 
fear  and  its  twin  brother,  worry.  In  fact,  nothing  has  done 
so  much  to  establish  a  reasonable  working  basis  of  the 
cause  of  neurasthenia  and  to  explain  some  of  the  remark- 
able results  that  have  been  secured  from  the  treatment  of 
conditions  of  this  character  by  means  of  organotherapy 
than  the  work  of  Walter  B.  Cannon,  at  Harvard  University, 
in  which  he  has  shown  that  the  emotional  factors  so  com- 
mon in  health  and  disease,  including  pain,  hunger,  fear  and 
rage,  brought  about  many  of  their  ordinary  physiological 
reactions  through  a  direct  influence  upon  the  adrenal  glands. 
This  explains  many  things  in  our  every-day  experience,  just 
as  it  does  many  other  things  in  clinical  practice,  especially 
in  the  functional  side  of  neurology. 

The  Endocrine  Aspect  of  the  Neuroses.  It  is  a  fact  that 
cannot  reasonably  be  denied  that  most  neurotic  conditions 
are  commonly  associated  with  various  endocrine  disturb- 
ances. Many  neurasthenics  habitually  complain  of  sensa- 
tions of  cold.  Nervous  chills  are  not  uncommon  and  cold 
hands  and  feet,  indefinite  muscular  pains  and  an  exagger- 
ated sense  of  physical  exhaustion  as  well  as  mental  inertia, 
are  the  rule  in  neurasthenia.  These  are  also  typical  endo- 
crine findings.  M.  Allen  Starr,  of  New  York  (Med.  Record, 
June  29,  1912) ,  connects  such  neuroses  with  dysthyroidisni 
or  at  least  errors  of  the  endocrine  system  as  a  whole  with 
more  prominent  manifestations  of  the  thyroid  and  adrenals. 
He  continues  his  description  of  these  cases  thus :  "Certain 
neurasthenics  are  extremely  restless  and  active  both  men- 
tally and  physically,  though  unable  to  keep  their  minds  on 
one  subject  for  any  length  of  time.  They  are  usually  anx- 
ious about  their  condition,  and  experience  a  sense  of  heat  in 
their  body  which  prevents  them  from  remaining  in  warm 
rooms.  Their  eyes  are  bright,  their  skin  shiny  and  moist, 
their  hair  glossy  and  they  are  usually  thin.  Other  typical 
features  are  tremor  about  the  hands,  exaggeration  of  the 
knee-jerks,  abnormal  sensations  of  hunger,  diarrhea  and 
excessive  menses.  They  sleep  badly,  are  hypersensitive  to 
sounds  and  often  complain  of  sudden  flashes  of  heat.  The 
pulse  is  often  abnormally  frequent,  80  to  90.  In  such  neu- 
rasthenics as  these  suspicion  should  be  awakened  that  there 
in  an  excess  of  secretion  of  the  thyroid  gland.  .  .  ." 


FUNCTIONAL  NEUROSES  183 

Here  the  Thyroid  Function  Test  mentioned  elsewhere  (Sec. 
IV,  Chap.  4)  may  be  of  much  service,  for  such  sympathetic 
irritability  may  be  of  adrenal  origin  or,  at  least,  not  a  minor 
form  of  hyperthyroidism.  Treatment  calculated  to  sedate 
the  sympathetic  irritability  simultaneously  with  a  search 
for  cause,  with  its  later  eradication,  is  much  more  likely  to 
be  satisfactory  than  to  ignore  the  endocrine  element  en- 
tirely— a  thing  which  has  been  quite  common  heretofore. 

Neuroses  of  Gonad  Origin.  Among  the  most  common 
endocrine  neuroses  are  those  associated  with  ovarian  dys- 
function, either  during  puberty  or  the  menopause,  or  the 
thirty-year  period  in  between.  It  is  very  well  understood 
that  menstrual  difficulties,  menopausal  derangements  and 
disturbed  functional  activity  of  the  ovaries  and  associated 
organs  cause  neuroses  of  all  shades,  from  a  slight  "fatigue 
neurosis"  to  a  "fear  neurosis"  which  may  even  metamor- 
phose into  insanity.  As  a  matter  of  fact,  the  so-called 
"ovarian  psychosis"  is  well  understood  as  being  due  to  dis- 
turbed ovarian  activity,  and  many  times  it  is  amenable  to 
treatment  calculated  to  regulate  the  disturbed  endocrine  bal- 
ance. In  other  words  certain  insanities  are  cured  by 
organotherapy. 

Again,  the  large  class  of  sexual  neuroses  dependent  upon 
overwork  or  abuse  of  the  gonads  may  show  themselves  in 
diverse  nervous,  circulatory  and  temperamental  manifesta- 
tions and  yet,  fundamentally,  be  due  to  the  original  de- 
rangement of  the  function  of  these  glands. 

With  these  few  points  in  mind,  we  are  led  to  acquire  an 
attitude  in  regard  to  the  etiology,  and  hence  to  the  treat- 
ment of  neurotic  conditions,  which  enables  us  to  class  them 
^respectively  as  disturbances  of  internal  secretion,  and 
likely  to  be  amenable  to  those  methods  of  treatment  known 
to  control  disorders  of  this  character.  To  recapitulate: 
There  may  be  an  effective  organotherapy  of  many  neuroses 
and  psychoses. 

As  one  prominent  neurologist  once  said  to  the  writer,  "In 
so  many  of  these  indefinite  nervous  cases,  we  neurologists 
find  ourselves  up  against  a  stone  wall  with  no  chance  to 
scale  it,  and  about  the  only  alternative  is  to  turn  around  and 
retrace  our  steps.  This  idea  of  yours  [the  idea  is  far  from 
being  my  own,  I  have  merely  picked  it  up  in  my  reading, 
and  shouted  about  it  a  little  louder  than  some  of  my  col- 
leagues— H.  R.  H.]  offers  us  some  hope  in  these  very  cases, 
and  I  would  not  be  surprised  if  the  endocrines  would  serve 
as  a  sort  of  a  scaling  ladder  to  get  over  that  terrible  blank 


184  PRACTICAL  ORGANOTHERAPY 

wall."  This  was  a  number  of  years  ago,  before  a  good 
many  recent  reports  and  opinions  had  been  published  on  the 
subject,  and  it  really  seems  that  the  vision  of  this  neurol- 
ogist is  being  realized  and  that  the  difficulty,  likened  to  the 
impossible,  unscalable  wall,  many  a  time  is  being  sur- 
mounted very  satisfactorily. 

The  principal  point  that  I  desire  to  make  concerns  the  im- 
portance of  a  possible  endocrine  factor  in  neuroses.*  I  do 
not  need  to  quote  many  authorities  and  fit  together  a  plexus 
of  statements  by  various  men  prominent  in  the  profession. 
The  fact  remains  that  the  endocrine  aspect  of  the  neuroses 
is  the  most  encouraging  of  all. 

Alimentary  Neuroses.  Toxemia  and  disturbed  adrenal 
functioning  react  directly  upon  the  digestive  tract.  Potten- 
ger,  of  Los  Angeles,  who  has  done  much  profitable  work  on 
the  relation  of  the  endocrines  and  the  sympathetic  system  to 
tuberculosis,  makes  the  following  statement  (Jour.  AM. A., 
Jan.  8,  1916) :  "The  adrenal  glands  are  supplied  through 
the  splanchnics ;  and  impulses  which  cause  a  general  sym- 
pathetic stimulation  stimulate  these  glands  also.  A  minute 
amount  of  adrenin  poured  into  the  blood  stream  has  the 
effect  of  producing  a  prolongation  of  the  condition  which  is 
brought  about  by  direct  sympathetic  stimulation;  thus 
adrenin  will  cause  a  dry  mouth,  impaired  digestion,  intes- 
tinal stasis  and  a  rapid  heart.  That  toxemia,  like  the 
emotional  states,  acts  by  stimulating  the  sympathetics  and 
by  prolonging  the  action  through  the  stimulation  of  the 
adrenals,  seems  quite  certain." 

Upham,  of  New  York,  in  a  consideration  of  mucous  colitis 
(N.  Y.  Med.  Jour.,  Sept.  21,  1918)  calls  attention  to  the 
sympathetic-vagus  balance  in  alimentary  disorders  as 
follows : 

"It  has  been  amply  demonstrated  that  stimulation  of  the 
vagus  in  health  produces  motor  activity  along  the  gastro- 
intestinal canal.  This  activity  is  held  in  check  and  con- 
trolled by  the  inhibition  from  the  sympathetic  nervous  sys- 
tem. The  wonderful  phenomenon  in  this  occurrence  is  the 
nerve  balance  in  the  normal  individual,  whereby  stimulation 
is  combated  by  just  enough  inhibition  to  produce  a  condition 
of  nervous  balance  with  resultant  normal  functioning  of  the 

*The  second  issue  of  Harrower's  Monographs  on  the  Internal  Secre- 
tions is  entitled:  "Neurasthenia:  An  Endocrine  Syndrome,"  and  con- 
tains a  wide  range1  of  information  culled  from  many  sources  which 
will  make  interesting  supplementary  reading.  (92  pp.,  price,  $1.25; 
annual  subscription,  $3.00) 


FUNCTIONAL  NEUROSES  185 

gastrointestinal  system.  But  in  an  individual  who  has  an 
over-active  vagus,  which  may  be  due  to  an  excess  of  nerve 
activity  of  that  structure,  there  occurs  a  series  of  spasmodic 
activities  throughout  the  gastro-intestinal  canal.  These 
spasmodic  activities,  when  in  the  stomach,  produce  areas  of 
ischemia  and  are  the  foundation  of  deficient  circulation 
which  makes  possible  the  location  of  infection  from  any 
systemic  source  and  the  production  of  gastric  ulcer.  The 
same  series  of  phenomena  occurs  in  the  large  intestine;  a 
condition  is  brought  about  which  gives  rise  to  spasmodic 
contractions  of  the  colon,  which  are  features  of  the  condition 
of  mucous  colitis."  Here  we  have  a  plausible  explanation  of 
two  phases  of  neurasthenia  which  are  unusually  resistant 
to  treatment — until  the  endocrine  aspect  is  appreciated. 

The  Search  for  Dyscrinism  in  the  Neuroses.  If,  then,  we 
will  consider  every  sufferer  with  a  functional  neurosis  from 
the  standpoint  of  the  internal  secretions,  we  will  imme- 
diately busy  ourselves  with  finding  and  controlling  ovarian 
dysfunction,  if  it  happens  to  be  present,  with  the  study  of 
the  patient  from  the  standpoint  of  the  thyroid  gland,  with 
its  paramount  control  of  detoxication  and  cell  chemistry  in 
general  and  with  at  least  a  thought  about  the  adrenals, 
which  are  very  likely  to  be  unusually  irritable  or  past  that 
stage,  in  which  case  we  will  attempt  to  modify  the  under- 
lying causes  of  this  irritation,  either  toxic,  endocrine  or 
emotional.  And  if  matters  have  reached  the  stage  where 
there  is  a  well-defined  adrenal  insufficiency — and  this  is 
perhaps  the  most  common  single  endocrine  manifestation  in 
individuals  suffering  from  neuroses — we  will  establish  its 
presence  to  our  satisfaction  by  the  study  of  the  blood  pres- 
sure, which  will  be  found  to  be  unusually  low ;  the  temper- 
ature, which  is  often  subnormal ;  the  elimination,  especially 
of  the  urinary  wastes,  which  are  usually  much  below  par; 
and  of  the  nutrition,  which  ordinarily  is  poor;  and  then  if 
we  can  consistently  make  ourselves  believe  that  a  given 
neurasthenic  patient  is  also  suffering  from  hypoadrenia,  we 
will  do  the  next  obvious  thing  and  treat  the  hypoadrenia — 
not  the  neurasthenia.  All  this  sounds  well  enough,  but  it  is 
"not  the  thing  y'know,"  as  they  are  wont  to  say  in  England. 
But  if  my  own  experience  is  any  criterion,  we  will  be  sur- 
prised many  times  at  the  remarkable  change  made,  not 
merely  upon  the  obvious  physiologic  factors  controlled  by 
the  adrenals  and  the  glands  associated  with  them  but  upon 
the  patient's  view  of  life,  general  health,  and  especially 
what  some  are  pleased  to  call  his  "pep." 


186  PRACTICAL  ORGANOTHERAPY 

Again,  if  any  other  endocrine  element  obtrudes  itself, 
surely  the  right  thing  to  do  is  to  go  after  it  "hammer  and 
tongs,"  and  the  principle  that  is  invariably  followed  in  all 
navies — clear  the  decks  before  action — is  the  best  and  only 
policy  to  follow  in  these  particular  cases.  If  there  are  dis- 
turbances of  these  glands  in  the  nature  of  insufficiencies  or 
otherwise,  we  have  something  with  which  to  occupy  our- 
selves very  tangibly;  and  since  the  organotherapy  of  endo- 
crine disorders  is  altogether  the  most  satisfactory  branch  of 
therapeutics,  after  we  remove  some  underlying  element 
which  happens  to  be  causative,  before  very  long,  in  addition 
to  reestablishing  the  condition  toward  which  we  are  direct- 
ing our  treatment,  we  find  that  the  neurasthenia  is  also 
responding. 

The  moral  of  this  little  sermon  is  simply  this:  Find  an 
endocrine  element  in  your  neurasthenic  patients  and  treat 
it,  and  you  may  be  surprised  at  the  ease  with  which  a  stub- 
born and  intractable  symptom-complex  fades  away. 

Some  Practical  Therapeutic  Deductions.  Naturally  the 
endocrine  treatment  of  neuroses  differs  with  circumstances. 
If  there  is  ovarian  dysfunction  in  the  nature  of  an  endocrine 
insufficiency  with  disturbed  menses,  a  protracted  wait  be- 
tween the  periods,  a  materially  reduced  flow  with  various 
associated  nutritional,  nervous  and  circulatory  disorders, 
use  the  formula  No.  4,  Thyro-Ovarian  Co.  (Harrow er) ,  in 
the  expectation  that  physiological  stimulation  of  not  merely 
the  ovaries  but  the  associated  endocrine  glands  may  rees- 
tablish ovarian  function  and,  at  the  same  time  remove  a 
part  or  all  of  the  foundation  of  the  neurasthenia.  The 
same  thing  applies  to  disturbances  of  this  character  at  the 
menopause.  Here  a  factor  to  which  the  body  has  accus- 
tomed itself  for  many  years  is  removed,  and  there  is  a 
resulting  disorganization  of  the  whole  hormone  balance. 
Mitigate  this  removal  by  adding  a  little  to  the  suddenly 
reduced  quantity  of  hormones,  and  it  will  be  found  that 
the  circulatory  and  nervous  conditions  clear  up  in  a  most 
remarkable  fashion.  On  the  other  hand,  if  the  ovaries  seem 
to  be  irritated,  the  length  of  time  between  the  periods  is 
reduced,  and  the  amount  of  flow  considerably  increased  with 
obvious  signs  of  pelvic  pain  and  discomfort,  antagonize  this 
ovarian  hyperfunction  by  using  mammary  substance  as 
represented,  for  example,  by  No.  38,  Mamma-Ovary  €o. 
(Harrower)  in  young  women  with  a  functional  difficulty, 
or  No.  40,  Mamma-Pituitary  Co.  (Harrower)  in  older 
women  with  a  heavier  flow  and  more  chronic  trouble;  and 


FUNCTIONAL  NEUROSES  187 

in  addition  to  reducing  the  immediately  obvious  symptom — 
menorrhagia — the  associated  neurotic  manifestations  usu- 
ally disappear  with  it. 

The  same  thing  applies  in  the  male.  Prostatic  difficulties 
are  very  commonly  associated  with  neurasthenia  and  quite 
frequently  remedied  very  nicely  by  applying  the  same 
fundamental  principles  as  those  just  mentioned;  for  in- 
stance, the  formula  No.  48,  Prostate  Co.  (Harrower)  not 
merely  has  been  known  to  reduce  local  prostatic  hyperes- 
thesia  and  mechanical  difficulties  resulting  from  prostatic 
hypertrophy  but  to  clear  away  at  the  same  time  the  morbid 
neurotic  state  which  may  be  dependent  in  a  large  measure 
upon  deranged  physiology  of  these  glands. 

I  have  already  discussed  the  adrenal  factor  in  neuras- 
thenia ("The  Adrenal  Glands  in  Health  and  Disease,"  Sec. 
IV,  Chap.  5) ,  and  many  ideas  of  others  have  been  gathered 
together  to  establish  the  underlying  importance  of  the  ad- 
renal glands  in  fatigue  neuroses.  The  subject  has  been 
given  even  further  consideration  in  a  book  which  I  pub- 
lished in  1919,  entitled,  "The  Adrenal  Glands  in  Every-Day 
Medicine,"  which  is  now  out  of  print,  and  in  the  fifth  (Janu- 
ary 1922)  issue  of  Harrower1 's  Monographs  on  the  Internal 
Secretions,  which  is  a  collection  of  data  from  scores  of 
sources  emphasizing  the  reality,  frequence  and  clinical  as- 
pects of  "Adrenal  Insufficiency."  (120  pages;  $1.50  post- 
paid; annual  subscription,  $3.00.) 

Suffice  it  to  say  that  the  physician  who  gives  to  the 
neurasthenic  with  obvious  hypoadrenia,  treatment  of  the 
ordinary  character  which  does  not  include  a  definite  effort 
to  reestablish  the  disturbed  endocrine  function,  is  destined 
to  more  frequent  failure  than  the  one  who  believes  in  a 
treatment  which  includes  this  with  all  other  indicated 
measures.  This  is  the  reason  for  many  splendid  results 
from  the  use  of  my  Adreno-Spermin  Co.  in  neuroses.  The 
adrenal  glands  are  supported,  and  functions  associated  with 
these  glands  are  simultaneously  encouraged.  As  a  result, 
the  low  blood  pressure  is  increased,  the  subnormal  morning 
temperature  is  raised  and  with  it  the  whole  chemistry  of 
the  body,  and,  as  a  result  of  that,  the  elimination  is  measur- 
ably enhanced — I  have  seen  a  twenty-four  hour  urea  figure 
as  low  as  .8  per  cent,  and  after  a  month's  treatment  found 
it  1.75  per  cent,  whereas  the  normal  is  probably  about  2  per 
cent.  With  all  these  changes  there  ought  to  be  a  marked 
change  for  the  better  in  the  neurasthenia,  which  hereto- 
fore may  have  been  treated  by  burdening  the  emunctories 


188  PRACTICAL  ORGANOTHERAPY 

and  paralyzing  the  nerve  endings  with  bromides  or  allowing 
matters  to  slide,  by  prescribing  what  is  often  erroneously 
called  a  rest  or  change  of  air. 

Functional  Endocrine  Neurasthenia.  At  a  recent  meet- 
ing of  the  British  Medical  Association,  held  June  1921,  at 
Cambridge,  England,  Dr.  Arthur  F.  Hurst,  physician  and 
neurologist  to  the  famous  Guy's  Hospital,  London,  called 
attention  to  the  fact  that  a  special  effort  must  be  made  to 
gain  a  clear  conception  of  what  is  meant  by  such  terms  as 
functional  neurosis,  psycho-neurosis,  neurasthenia,  etc.  In 
his  opinion  a  functional  disorder  was  one  which  did  not 
depend  upon  organic  change;  it  might  be  either  biochemi- 
cal or  nervous  in  origin.  Neurasthenia  generally  has  been 
classified  as  a  neurosis,  but  it  really  depends  upon  definite, 
though  evanescent,  organic  changes  in  the  central  nervous 
system  and  in  the  adrenals  and  possibly  other  endocrine 
glands  resulting  from  mental  and  physical  exhaustion  and 
chronic  intoxication.  According  to  Dr.  Hurst,  therefore, 
neurasthenia  is  really  a  temporary  organic  condition  and 
not  a  functional  disorder. 

From  the  writer's  personal  standpoint  neurasthenia  is 
still  a  functional  neurosis,  merely  because,  despite  the  fact 
that  the  endocrine  glands  are  very  definitely  involved  in  its 
etiology,  the  influence  is  of  a  temporary  functional  character 
and  the  changes  in  either  the  nervous  system  or  the  endo- 
crine system  do  not  seem  to  be  a  structural  variety.  ^  When 
there  are  definite  anatomical  changes  in  the  organism  we 
speak  of  them  as  organic.  When,  however,  there  is  a  change 
in  the  activity  of  an  organ  doubtless  the  condition  is  purely 
functional. 

When  those  factors  which  are  known  to  deplete  the  endo- 
crine glands,  and  especially  in  the  instance  under  discus- 
sion, the  adrenal  system,  result  from  mental  as  well  as 
physical  exhaustion  and  chronic  toxemic  conditions,  obvi- 
ously the  change  in  the  adrenal  glands  does  not  necessarily 
have  to  be  organic  in  character  and,  therefore,  its  influence 
upon  the  central  and  sympathetic  nervous  system  is  equally 
functional. 

While  I  differ  with  Dr.  Hurst,  and  I  think  that  many  of 
my  readers  will  agree  with  me,  there  is  a  great  deal  of  im- 
portance to  be  laid  on  his  reference  to  the  influence  of  vari- 
ous forms  of  exhaustion  and  intoxication  upon  the  adrenal 
system,  and  therefore,  that  many  such  individuals  funda- 
mentally are  cases  of  neurasthenia  of  endocrine  origin. 

Tom  Williams,  of  Washington,  and  a  good  many  other 


FUNCTIONAL  NEUROSES  189 

aggressive  neurologists  in  this  country  and  France  have 
very  definitely  connected  the  adrenal  glands  with  the  origin 
of  neurasthenia.  Toxemias  of  all  varieties — those  due  to 
improper  diet,  as  for  example,  the  use  of  coffee  and  exces- 
sive amounts  of  meat;  from  putrefactive  products  of  dis- 
turbed alimentary  function ;  from  foci  of  bacterial  infection 
in  various  parts  of  the  organism;  and  also  the  product  of 
a  deficient  endocrine  activity  of  the  thyroid  gland,  which  is 
responsible  very  largely  for  maintaining  the  normal  chemi- 
cal activities  of  the  cells  of  the  body  and  keeping  the  met- 
abolism up  to  par,  and  finally  the  abnormal  toxemias  due  to 
nervous  exhaustion,  i.e.,  mental  overwork,  general  cellular 
overwork  and,  therefore,  an  excessive  fatigue  syndrome — 
all  exert  the  same  fundamental  influence  upon  the  adrenal 
glands.  They  overstimulate  them  and  this  stimulation  very 
uniformly  results  in  depletion,  with  a  resulting  hypoadrenia, 
which  is  so  commonly  a  part  of  the  usual  syndrome  of 
neurasthenia.  In  addition  to  the  usual  neurasthenic  mani- 
festations which  are  so  uniformly  found,  we  expect  to  find 
changes  in  the  systolic  blood-pressure — the  sphygmoma- 
nometer  sometimes  showing  a  blood-pressure  of  100,  90, 
or  even  80  millimeters — lessened  elimination  of  the  urinary 
wastes  and  especially  the  24-hour  urea,  lowered  general 
chemistry  as  manifested  in  malnutrition  and  a  subnormal 
temperature  and,  finally  and  most  important,  a  tendency 
towards  asthenia  of  a  most  aggravated  type. 

These  cases  need  detoxication.  They  need  a  diet  which 
will  prevent  the  ingestion  of  as  many  as  possible  of  the  poi- 
sons which  are  known  to  stimulate  the  adrenal  system. 
They  need  rest  and  a  change  of  environment  in  order  that 
the  disturbances  of  the  mind  and  brain  may  be  reduced  to 
a  minimum,  so  that  the  emotional  factors,  which  so  often 
cause  adrenal  overstimulation,  can  be  modified. 

Finally  and,  to  my  mind,  as  important  as  any  single 
measure  in  the  treatment  of  these  neurasthenias,  I  urge 
functional  support  of  the  adrenal  glands  by  means  of  or- 
ganotherapy. It  is  possible  to  replace,  in  a  large  degree, 
the  principles  that  the  adrenal  glands  are  not  supplying  as 
much  of  as  they  should,  just  exactly  as  one  can  supply  a 
missing  thyroid  hormone  or  the  principle  from  the  ova- 
ries. This  has  been  done  many  hundreds  of  times  by  the 
use  of  a  formula  containing  adrenal  substance  (total  gland 
including  the  cortex),  a  small  dose  of  thyroid  with  spermin 
and  glycerophosphate  of  calcium.  I  am  proud  to  be  able 
to  associate  my  name  with  the  origin  and  preparation  of 


190  PRACTICAL  ORGANOTHERAPY 

this  excellent  pluriglandular  support,  which  is  used  with 
advantage  in  practically  all  forms  of  neurasthenia. 

There  is  a  large  and  growing  bibliography  of  communi- 
cations which  support  the  position  that  I  take  in  this  mat- 
ter. Some  of  these  authors  are  convinced  and  obviously 
enthusiastic  about  "a  new  find,"  while  others  seem  to  be 
reluctant  to  admit  that  our  estimate  of  the  etiology  and 
treatment  of  the  neuroses  must  be  revised  radically.  We 
read  such  things  as  this :  "All  these  seem  to  point  to  a  pos- 
sible relation  between  the  neurasthenia  and  ..."  etc. — 
and  we  feel  justified  in  smiling  to  ourselves  and  recalling 
some  patients  who  "seemed"  to  be  quite  pleased  when  they 
last  reported. 

It  has  been  said  by  Tom  Williams,  of  Washington,  that 
the  word  "neurasthenia"  is  a  cloak  to  cover  our  short- 
comings in  diagnosis.  He  is  right,  and  I  believe  that  this 
neurosis  properly  might  be  called  an  "endocrinosis,"  if  such 
a  new  word  is  permissible. 


SECTION  V.    CHAPTER  5 
THE  TREATMENT  OF  OVARIAN  DISORDERS 


Functional  ovarian  disorders  include  developmental,  men- 
strual and  climacteric  disturbances  and  represent  a  very 
large  proportion  of  all  the  diseases  of  women.  We  have 
seen  in  the  section  on  Diagnosis  that  the  ovaries  are  respon- 
sible for  many  factors  in  the  normal  development  and  func- 
tioning of  the  body  and  that  they  themselves  are  intimately 
associated  with  other  glands  of  internal  secretion,  notably 
the  thyroid  and  pituitary. 

As  has  been  explained,  there  are  two  chief  classes  of 
ovarian  dysfunction — insufficient  endocrine  activity  and  hy- 
persecretion.  Since  the  ovaries  play  such  an  important  part 
in  the  essential  changes  known  as  secondary  sex  character- 
istics, any  ovarian  insufficiency  that  manifests  itself  before 
development  is  complete  will  cause  more  extensive  results. 

Functional  Ovarian  Insufficiency.  As  a  result  of  various 
causes,  nutritional  (hormonic),  nervous  and  circulatory, 
ovarian  function  may  be  insufficient.  I  think  this  is  quite 
the  commonest  glandular  insufficiency  among  women,  unless 
perhaps  we  should  give  first  place  to  the  adrenal  insuffi- 
ciency which  follows  toxemias,  acute  infectious  disease  and 


OVARIAN  DISORDERS  191 

shock.  At  all  events,  hypo-ovarism  is  a  most  useful  finding 
in  general  practice  and  the  chief  results  are  amenorrhea, 
dysmenorrhea  and  the  various  neuroses  resulting  from 
these  disturbances.  The  treatment  of  ovarian  insufficiency 
with  organotherapy  is  one  of  the  accepted  organothera- 
peutic  procedures,  and  while  there  is  some  difference  of 
opinion  as  to  the  relative  merits  of  glandular  extracts  of 
the  corpus  luteum  or  total  ovary,  there  can  be  no  doubt  that 
the  principle  of  homostimulation  fully  outlined  in  the  sec- 
ond section  of  this  book  may  be  applied  with  great  advan- 
tage in  the  control  of  conditions  of  this  character. 

For  fifteen  years  or  more,  functional  pelvic  disorders  and 
the  reflex  disturbances  resulting  therefrom  have  been 
treated  with  corpus  luteum  or  ovary  alone,  and  for  obvious 
reasons  no  method  or  drug  can  begin  to  take  the  place  of 
such  preparations,  merely  because  the  same  principle  ap- 
plies that  does  in  hypothyroidism — the  body  is  not  making 
enough  of  a  certain  substance  and  is  suffering  from  the  lack 
of  the  stimuli  made  possible  by  that  substance;  we  inter- 
vene by  securing  a  similar  substance  from  animals,  admin- 
ister it  to  the  patient,  and  the  body  is  able  to  take  it  up 
and  use  it  to  reestablish  its  own  affairs.  Hence,  extracts 
of  this  character  not  merely  stimulate  the  gland  which 
corresponds  to  that  from  which  it  was  made,  but  replace,  in 
a  degree,  the  hormone  that  may  be  lacking. 

Numerous  clinical  experiences  by  literally  hundreds  of 
physicians  now  connect  the  thyroid  gland  with  the  ovaries. 
A  number  of  quotations  from  a  communication  by  Oliver 
T.  Osborne  emphasizing  this  fact  will  be  found  in  the  other 
chapter  on  the  diagnostic  aspects  of  ovarian  disturbances 
(Sec.  IV,  Chap.  8)  which,  by  the  way,  should  be  read  in 
conjunction  with  these  remarks.  Suffice  it  to  say  that 
hypothyroidism  and  hypo-ovarism  go  together  clinically  and 
deserve  to  be  treated  together  organotherapeutically. 

When  I  was  in  Paris  in  1913,  I  learned  that  Prof.  Paul 
Dalche,  of  the  Hotel  Dieu,  was  in  the  habit  of  routinely 
adding  a  centigram  a  day  of  thyroid  extract  to  the  ovarian 
treatment  of  menstrual  difficulties,  the  reason  being  that 
sometimes  the  ovarian  difficulty  was  really  of  thyroid  ori- 
gin more  than  of  ovarian  origin,  and  while  direct  ovarian 
stimulation  might  be  good,  a  consideration  of  the  associ- 
ated and  causative  elements  at  the  same  time  would  be 
much  better. 

The  same  principle  applies  in  regard  to  the  pituitary 
gland.  We  know  that  pituitary  insufficiency  causes  ovarian 


192  PRACTICAL  ORGANOTHERAPY 

insufficiency;  hence,  if  we  have  a  case  of  functional  hypo- 
ovarism,  how  do  we  know  that  there  is  not  underlying  it 
a  pituitary  insufficiency?  And,  on  the  principle  which  I 
have  outlined  in  my  hypothesis  of  hormone  hunger  (see 
Sec.  II,  Chap.  5),  the  body  is  capable  of  making  the  most 
use  out  of  the  things  that  are  given  to  it  in  proportion  to 
the  respective  needs  of  the  various  organs  which  may  be 
involved  in  the  symptom-complex. 

The  Thyroid-Ovarian  Relations.  A  recapitulation  of  my 
own  opinion  of  the  close  relationship  of  the  thyroid  gland 
and  the  ovaries,  based  on  personal  experiences,  is  as  fol- 
lows :  The  thyroid  hormone  is  largely  instrumental  in  estab- 
lishing gonad  function.  One  of  the  chief  causes  of  the  not 
infrequent  enlargement  of  the  thyroid  at  puberty  is  that 
it  has  a  much  larger  job  to  accomplish  for  the  moment, 
and,  lacking  the  capacity  to  do  it  without  structural  change, 
it  hypertrophies  temporarily  in  an  effort  to  render  its  best 
service.  Again,  hypothyroidism  indeed  favors  amenorrhea, 
and  one  of  the  commonest  results  of  the  minor  forms  of 
hypothyroidism  is  a  change  in  the  amount  and  frequency 
of  the  menses,  tending  very  commonly  toward  amenorrhea. 
To  my  way  of  thinking,  this  is  because  the  ovaries  are  in 
the  habit  of  demanding  of  the  thyroid  a  certain  hormone, 
or  arousing  influence,  which,  because  of  some  additional 
work  set  upon  the  thyroid,  perhaps  in  the  nature  of  detoxi- 
cation  or  of  some  other  endocrine  demand  upon  its  capacity, 
has  either  diverted  the  thyroid  assistance  or  actually  les- 
sened it.  I  believe  that  the  best  proof  that  this  position  is 
based  upon  good  grounds  is  the  fact  that  thyroid  therapy 
so  very  often  is  useful  in  amenorrhea.  Dalche,  as  we  have 
seen,  believes  that  the  thyroid  encourages  ovarian  activity, 
and  that  thyro-ovarian  therapy  is  more  efficacious  than 
either  of  these  two  single  organotherapeutic  measures — 
ovarian  and  thyroid. 

The  reciprocal  relations  between  the  thyroid  and  the 
ovaries  are  unquestioned.  I  have  seen  many  cases  of  hypo- 
thyroidism that  have  been  benefited  materially  by  arousing 
the  ovarian  activity  which  was  simultaneously  deficient. 
My  experience  is  sufficiently  extensive — I  am  fortunate  in- 
deed in  having  many  correspondents  throughout  the  world, 
some  of  whom  see  fit  to  bring  their  troubles  to  me  for  con- 
sideration— to  have  found  cases  in  whom  a  hypothyroidism 
had  been  treated  with  comparatively  unsatisfactory  results, 
and  lo  and  behold,  the  simultaneous  consideration  of  the 
associated  ovarian  trouble  touches  the  miraculous  button 


OVARIAN  DISORDERS  193 

which  sets  things  right.  Hence,  there  must  be  some  rela- 
tion between  the  reestablishment  of  an  ovarian  activity  and 
the  control  of  an  associated  thyroid  trouble.  In  other  words, 
it  is  not  always  the  thyroid  that  is  entirely  responsible  in 
ovarian  troubles,  but  the  ovaries  may  be  partly  responsible 
for  some  of  the  troubles  in  athyroid  conditions.  The  wisest 
way,  after  all,  is  always  to  consider  these  glands  together, 
which  my  readers  know  full  well  I  have  urged  times  with- 
out number. 

Pluriglandular  Ovarian  Therapy.  The  Boston  gynecolo- 
gist, William  P.  Graves,  in  a  paper  read  before  the  Amer- 
ican Gynecological  Society  in  1919,  reports  that  the  general 
tonic  effect  of  organotherapy  was  especially  present  when 
other  pluriglandular  disturbances  accompanied  the  ovarian 
insufficiency.  He  says,  "The  stimulating  effect  of  the  ovar- 
ian residue  could  sometimes  be  enhanced  by  the  addition  of 
thyroid  and  the  anterior  lobe  extracts." 

If  you  have  a  given  endocrine  dysfunction  involving  the 
thyroid  and  ovaries,  treat  them  together — the  selective  ca- 
pacity of  the  cells  will  determine  how  much  and  how 
quickly  your  endocrine  remedies  are  appropriated  (or  not, 
as  the  case  may  be) — and,  needless  to  say,  the  confidence 
that  was  initiated  by  my  experience  in  Paris,  and  the 
things  which  I  saw  and  heard  there,  and  have  read  since, 
have  been  multiplied  a  thousand  fold  by  the  most  flattering 
comments  that  one  could  really  ask  for,  sent  to  this  office 
about  the  comparative  advantages  of  the  Thyro-Ovarian  Co. 
(Harrower)  over  thyroid  alone  or  corpus  luteum  alone. 

As  this  is  read  for  the  printer,  a  physician  in  Seattle 
writes  asking  if  I  have  seen  a  paper  in  the  New  York  Medi- 
cal Journal  (Oct.  5,  1921)  by  John  C.  Hirst,  of  Philadel- 
phia. He  advises  me  to  read  this  statement  for  my  en- 
couragement : 

"We  are  only  at  the  threshold  of  the  problem  of  all  the 
glands  of  internal  secretion.  I  believe  that  future  develop- 
ment will  be  along  the  lines  of  pluriglandular  therapy,  due 
to  the  probable  correlation  between  the  pituitary,  thyroid, 
mammary  gland,  suprarenal,  and  ovary,  rather  than  in  the 
use  of  single  extracts.  Especially  will  this  hold  true  in  the 
developmental  anomalies  of  the  genitalia." 

Amenorrhea  of  all  shades,  as  well  as  dysmenorrhea,  and 
many  of  the  intangible  circulatory  and  nervous  disturbances 
associated  with  these  disorders  are  quite  the  most  satis- 
factorily treated  by  pluriglandular  therapy,  for  the  rea- 
sons already  given.  For  years  I  have  been  using  with 

13 


194  PRACTICAL  ORGANOTHERAPY 

marked  success  a  formula  now  called  No.  4,  Thyro-Ovarian 
Co.  (Harrower) ,  which  contains,  in  addition  to  ovarian  sub- 
stance with  corpus  luteum,  a  small  dose  each  of  desiccated 
thyroid  gland  and  total  pituitary  substance.  It  is  recom- 
mended as  a  part  of  the  treatment  of  the  usual  functional 
pelvic  derangements  of  ovarian  origin  and  is  believed  to 
excel  corpus  luteum  alone,  merely  because  the  luteal  func- 
tion is  practically  never  involved  exclusively. 

Routine  Administration  of  Thyro-Ovarian  Co.  Since  the 
ovarian  hormone  function  is  cyclic  and  varies  considerably 
during  the  month,  one  can  increase  the  value  of  this  pluri- 
glandular  formula  by  arranging  the  dosage  so  that  it  is 
omitted  at  certain  periods  and  pushed  when  likely  to  have 
the  widest  physiological  effect.  Incidentally,  this  is  quite 
a  convenience  to  the  patient  and,  at  the  same  time,  reduces 
the  expense  of  the  treatment.  Prior  io  the  consummation 
of  this  monthly  task — at  the  very  time  when  the  nervous 
and  circulatory  difficulties  which  accompany  amenorrhea 
are  greatest — we  can  reenforce  the  hormone  function  in 
proportion  to  the  needs  by  increasing  the  dose;  hence  I 
have  suggested  the  following  cyclic  method  of  administer- 
ing Thyro-Ovarian  Co.  which  has  proved  very  satisfactory: 
Instruct  the  patient  to  omit  the  remedy  entirely  for  a  period 
of  ten  days  following  the  onset  of  the  menstrual  flow.  This 
includes  the  whole  menstrual  time,  which  is  believed  to  be 
just  after  the  time  when  the  ovarian  endocrine  activity  has 
reached  its  monthly  peak.  t)uring  the  next  ten  days,  i.  e., 
the  middle  of  the  month,  one  5-grain  dose  is  given  three 
times  a  day,  while  for  ten  days  or  a  week,  depending  upon 
circumstances,  immediately  before  the  next  flow  the  dose 
may  be  pushed  or  doubled.  This  is  again  stopped  as  soon 
as  the  flow  shows  itself;  and  since  there  is  but  a  short 
time  during  each  menstrual  month  that  the  ovaries  can  be 
stimulated  effectually  and  this  organotherapy  is  a  means 
of  reestablishing  a  normal  cellular  activity,  such  treatment 
should  be  continued  for  a  number  of  months,  and  if  the  re- 
sults are  good — and  very  commonly  they  are  splendid — it 
should  be  continued  for  some  little  time  after  an  apparent 
cure  has  been  secured. 

Menopausal  Difficulties.  The  disconcerting  circulatory 
disturbances  connected  with  the  change  of  life,  and  enum- 
erated elsewhere,  are  evidently  due  to  the  same  sort  of  a 
cause  as  other  forms  of  amenorrhea  earlier  in  life  and  re- 
spond very  satisfactorily  to  the  replacement  of  a  part  of 
the  necessary  quantity  of  ovarian  hormones.  In  the  climac- 


OVARIAN  DISORDERS  195 

teric  especially,  the  value  of  pluriglandular  therapy  should 
be  obvious,  for  it  is  well  known,  for  instance,  that  during 
the  decade  between  forty  and  fifty,  serious  forms  of  hypo- 
thyroidism  in  women  are  most  common  and  that  the  meno- 
pausal  difficulties  are  by  no  means  entirely  of  ovarian 
etiology. 

Neuroses,  Psychoses  and  Insanity.  Unfortunately,  in 
some  remarkable  manner  the  imbalance  due  to  dysovarism 
may  cause  more  or  less  serious  disturbances  of  a  mental 
character,  and  one  of  the  dreaded  results  of  severe  ovarian 
dystrophies  is  insanity.  We  prefer  to  call  it  "ovarian  psy- 
chosis" and,  irrespective  of  the  complexity  of  the  cause, 
to  attempt  its  treatment  by  the  regulation  of  the  ovarian 
difficulty  that  shows  itself  simultaneously.  In  other  words, 
an  ovarian  psychosis  may  respond  to  ovarian  therapy  just 
as  other  less  serious  nervous  conditions ;  and  while  the  pros- 
pects are  not  so  good  because  the  trouble  is  more  serious 
and  comprehensive,  in  its  effects,  they  are  better  than  in 
the  treatment  of  the  other  forms  of  psychosis.  This  means 
that  mental  disturbances  in  women  that  may  be  connected 
with  ovarian  dysfunction  may  be  modified  favorably  by  di- 
rect attention  to  the  accompanying  ovarian  disturbance.  A 
number  of  experiences  of  this  character  following  the  use  of 
my  Thyro-Ovarian  Co.  have  been  brought  to  my  attention, 
one  case  being  particularly  interesting.  I  was  surprised  to 
receive  a  letter  from  San  Diego  in  which  the  following  sen- 
tence appeared:  "I  am  getting  some  wonderful  results. 
One  young  lady  who  was  diagnosed  as  suffering  with  de- 
mentia precox,  has  made  a  complete  recovery.  They  sent 
this  lady  to  a  sanitarium  and  paid  out  about  seven  hundred 
dollars  with  absolutely  no  apparent  benefit.  I  put  her  on 
the  Thyro-Ovarian  Co.,  and  sent  her  up  into  the  moun- 
tains. One  month  did  the  work.  She  does  not  even  have 
a  suggestion  of  her  former  trouble."  I  immediately  wrote 
the  doctor  that  I  did  not  believe  that  the  case  could  have 
been  properly  diagnosed  and  that  the  condition  evidently 
was  an  ovarian  psychosis  and  not  dementia  precox.  Eleven 
months  later,  I  had  occasion  to  visit  this  physician  and 
learned,  to  my  pleasure,  that  there  had  been  no  recurrence 
of  the  mental  aberration  and  that  the  young  lady  was  in 
better  health  than  at  any  time  previously. 

Organic  Ovarian  Insufficiency — Infantilism.  If  for  some 
reason  (usually  associated  with  insufficiency  of  the  thyroid 
or  pituitary,  or  both)  the  ovaries  do  not  develop  and  the 
internal  secretory  function  of  the  corpora  lutea  does  not 


196  PRACTICAL  ORGANOTHERAPY 

materialize  at  the  ordinary  time,  i.  e.,  at  puberty,  there  will 
be  no  menstruation.  In  addition  to  this,  the  growth  and 
development  of  the  essential  reproductive  organs,  including 
the  uterus  and  ovaries  themselves  and  the  external  geni- 
talia,  as  well  as  the  breasts,  will  be  prevented.  This  condi- 
tion is  known  as  hypoplasia,  status  hypoplasticus,  or 
infantilism;  and  while  there  are  some  prospects  for  its 
treatment,  obviously  they  are  not  so  good  as  in  less  serious 
disturbances  that  show  themselves  later. 

The  treatment  of  infantilism  is  not  an  encouraging  propo- 
sition. It  should  involve  a  study  of  the  possible  causes  in 
other  ductless  glands,  including  a  test  of  thyroid  function, 
a  study  of  the  pituitary  gland,  both  from  the  standpoint 
of  the  radiographic  examination  of  the  sella  turcica  and  the 
measurement  of  sugar  tolerance,  etc.,  and  search  should  be 
made  with  the  fluoroscope  for  a  persistent  thymus.  All  of 
this,  in  addition  to  the  careful  study  of  the  whole  body,  as 
well  as  a  pelvic  examination  if  this  is  at  all  feasible.  It  is 
essential  to  strip  the  patient  because  infantilism  does  not 
necessarily  involve  developmental  difficulties  alone —  it  is 
quite  a  different  proposition  from  cretinism,  although  in- 
fantilism is  one  of  the  symptoms  of  cretinism — while  it 
does  cause  definite  changes  in  the  form  and  distribution  of 
hair.  If  the  usual  pads  of  fat  on  the  hips  and,  generally 
speaking,  the  feminine  contour  as  seen  from  behind  is  ab- 
sent, and  the  axillary  and  pubic  hair  is  considerably  less- 
ened or  entirely  absent  and  mammary  development  does  not 
appear,  or  is  defective,  in  all  probability  we  have  a  case  of 
true  infantilism.  There  are  only  two  things  to  do  in  cases 
of  this  character :  first,  to  remove  any  obvious  causes  of  the 
trouble  as,  for  example,  malnutrition  or  a  persistent  thy- 
mus; and  second,  to  homostimulate  not  merely  the  ovaries 
which  may  be  present  in  a  rudimentary  form,  but  also  the 
glands  which  control  ovarian  function  and  in  which  a  dis- 
turbed internal  secretory  activity  may  be  taking  place  which 
may  be  the  underlying  cause  of  the  difficulty.  Hypopitu- 
itarism  and  the  more  serious  forms  of  hypothyroidism  both 
may  bring  this  about,  and  the  only  treatment  worth  consider- 
ing is  endocrine  treatment.  Such  organotherapy  should  con- 
sist of  the  persistent  administration  of  pluriglandular  form- 
ulas including  the  thyroid,  pituitary  and  ovary  (i.  e.,  either 
No.  4,  Thyro-Ovarian  Co.  (Harrow  er) ,  or  No.  73,  Gonad- 
Ovarian  Co.  (Narrower) — a  similar  preparation  to  No. 
4,  to  which  a  generous  dose  of  anterior  pituitary  substance 
has  been  added).  The  dosage  must  be  continued  for  a  long 


OVARIAN  DISORDERS  197 

period  and  may  be  supplemented  by  other  circulatory  stimu- 
lating- measures  like  hydrotherapy  and  osteopathy.  In  fact, 
I  know  of  several  cases  of  infantilism  that  seem  to  have 
been  very  materially  benefited  by  the  neuro-circulatory 
changes  which  have  resulted  from  intelligent  spinal  man- 
ipulation. 

Ovarian  Irritability — Hyperovarism.  Fortunately,  the 
most  common  functional  disorder  of  the  ovaries  is  an  in- 
sufficiency, and  the  opposite  condition  is  comparatively  rare. 
I  say  "fortunately,"  because  hyperovarism  is  a  more  serious 
and  more  difficult  disorder  than  its  physiological  opposite, 
just  as  thyroid  excess  is  more  difficult  to  handle  than  thy- 
roid insufficiency. 

Ovarian  irritability  is  clinically  evident  when  there  is 
marked  pelvic  congestion  and  discomfort  with  menorrhagia 
(both  forms — prolonged  and  excessive  menses,  and  too  fre- 
quent periods),  and  sex  irritability,  which  may  show  itself 
as  erethism,  nymphomania,  or  even  insanity. 

The  cause  varies — often  it  is  the  result  of  structural 
change,  or,  again,  it  is  purely  functional,  and  the  result  of 
mental  or  sexual  stimuli.  Pelvic  infections  are  prominent 
in  the  etiology  of  this  condition,  just  as  foci  of  infection 
are  among  the  commonest  causes  of  hyperthyroidism. 

The  treatment  is  not  easy,  for  usually  many  of  the  fac- 
tors involved  are  beyond  the  physician's  control.  Depletive 
local  treatment  is  good,  especially  when  the  uterus  is  large 
and  boggy.  I  advise  magnesium  sulphate  gelatine  tampon- 
ade  for  several  weeks.  Psychic  control  is  especially  needed 
where  introspection,  mental  sex  stimulation  and  incomplete 
intercourse  are  discovered  on  questioning1.  The  Robert  W. 
Chambers  style  of  "literature"  has  caused  menorrhagia  in 
girls  and  young  women,  and  the  treatment  is — "Cut  it  out 
for  good." 

The  most  satisfactory  organotherapy  is  mammary  sub- 
stance. This  is  the  physiological  antagonist  to  ovarian  func- 
tion just  as  the  mammae  and  ovaries  normally  antagonize 
one  another.  The  whole  subject  of  mammary  therapy  is 
considered  fully  in  Sec.  V,  Chap.  9,  "The  Control  of 
Menorrhagia." 

Two  formulas  on  my  list  are  recommended  in  men- 
orrhagia and  hyperovarism.  No.  38,  Mamma-Ovary  Co. 
(Harroiver),  for  girls  and  young  women,  where  the  dys- 
ovarism  leans  towards  excess,  i.  e.,  the  flow  is  too  frequent 
or  too  heavy,  or  both.  No.  40,  Mamma-Pituitary  Co.  (Nar- 
rower), is  used  in  older  women,  especially  those  who  are 


198  PRACTICAL  ORGANOTHERAPY 

at  "the  change"  and  those  who  have  fibroids.  The  dosage 
of  either  of  the  above  is  as  follows :  One  t.  i.  d.,  a.  c.,  double 
three  days  before  and  during  menses,  omit  for  one  week. 
Repeat. 

Ovarian  Poisoning.  Still  one  more  feature  of  dysovarism 
must  be  mentioned:  As  we  have  learned,  there  is  a  condi- 
tion which  has  been  called  ovarian  poisoning  and  which  re- 
sults from  perversion  of  the  function  of  the  ovarian  cells, 
usually  associated  with  structural  changes  such  as  the  de- 
velopment of  tumors,  etc.  This  dysovarism  is  far  more 
serious  than  any  of  the  functional  conditions  mentioned 
previously;  and  while  the  ultimate  successful  treatment 
calls  for  the  surgical  removal  of  the  abnormal  tissue,  it  may 
be  that  there  is  a  serious  adrenal  depletion  as  a  result  of  the 
toxemia  as  well  as  the  series  of  difficulties  which  are  due 
to  ovarian  insufficiency.  In  other  words,  in  those  cases 
where  the  manifestations  of  ovarian  hypofunction  are 
marked  and  they  are  associated  with  the  syndrome  of  ad- 
renal insufficiency,  which  includes  marked  fatigability,  low 
blood  pressure  and  generally  reduced  cell  chemistry,  it  may 
be  advisable  to  combine  adrenal  support  with  the  organo- 
therapeutic  regulation  of  the  ovarian  difficulty,  and  for 
cases  of  this  character  the  formula  No.  79,  Adreno-Ovarian 
Co.  (Harrower),  may  be  advisable.  The  dose  and  method 
of  administration  are  quite  similar  to  the  thyro-ovarian 
preparation  already  discussed. 

Conclusions  About  Functional  Ovarian  Disorders.  The 
following  conclusions  seem  to  the  writer  to  be  both  logi- 
cal and  worthy  of  repeated  emphasis: 

1.  It  is  accepted  that  the  ovarian  function  involves  the 
production  of  one  or  more  internal  secretions. 

2.  Ovarian  function  is  influenced  directly  and  indirectly 
by  the  other  endocrine  glands  and  it  in  turn  exerts  an  in- 
fluence upon  the  endocrine  glands. 

3.  The  thyroid  encourages  and  favors  ovarian  activity 
— the  cretin  does  not  develop  sexually  and  acquired  hypo- 
thyroidism  usually  means  ovarian  insufficiency. 

4.  On  the  other  hand,  hypo-ovarism,  especially  at  the 
menopause,    favors    hypothyroidism — myxedema    is    more 
common  in  women,  and  nine  out  of  ten  cases  occur  in  the 
decade  from  40  to  50. 

5.  The  pituitary  is  related  to  ovarian  disorders — hypo- 
pituitarism  causes  functional  as  well  as  organic  sex  dys- 
trophies.    The  Froehlich  syndrome  includes  amenorrhea, 
obesity  and  atrophy  of  the  sex  organs. 


PITUITARY  DYSFUNCTION  199 

6.  Also  in  functional  ovarian  insufficiencies  other  glands 
may  attempt  to  "help  out"  vicariously,  causing  goitre  or 
pituitary  headache  as  the  case  may  be. 

7.  The  intimacy  of  these  glands  predicates  plurigland- 
ular  difficulties  when  one  of  them  happens  to  be  affected. 

8.  Amenorrhea  or  dysmenorrhea — delayed,  lessened  or 
difficult  menses  as  well  as  sterility  and  asexualism — in  a 
word,  hypo-ovarism,  is  never  an  ovarian  disorder  pure  and 
simple.    Dalche,  of  Paris,  advises  thyroid  in  all  cases  need- 
ing ovarian  therapy  (save  only  in  hyperthyroidism) . 

9.  Conclusion :  Ovarian  dysfunction  usually  includes  thy- 
roid and  pituitary  dystrophies  as  well,  either  as  cause  or 
effect.    The  opposite  is  equally  true.     If  organotherapy  is 
advisable — and  it  is — pluriglandular  therapy  is  more  likely 
to  reach  a  pluriglandular  disorder  than  corpus  luteum  or 
ovary  alone. 

This  in  brief  is  why  Thyro-Ovarian  Co.  (Harrower) — a 
combination  of  corpus  luteum,  ovarian  substance,  thyroid 
and  total  pituitary  gland  in  proper  proportion — is  superior 
to  corpus  luteum  or  ovarian  substance  alone. 


SECTION  V.    CHAPTER  6 
THE  PITUITARY  FACTOR  IN  DYSOVARISM 


In  the  previous  chapters  there  have  been  occasional  hints 
of  the  influence  that  the  pituitary  gland  plays  in  ovarian 
dysfunction,  and  this  aspect  of  the  subject  is  so  important 
that  it  seems  well  to  reiterate  these  briefly  stated  facts  and 
supplement  them  with  other  information  to  add  emphasis 
to  a  very  important  and  usually  overlooked  subject. 

The  Hypophysis  Cerebri,  or  pituitary  gland,  is  still  quite 
a  mysterious  organ,  and  a  majority  of  the  profession  do 
not  pay  much  attention  to  it  at  all.  It  is  known,  in  a  sort 
of  subconscious  way,  that  there  is  such  an  organ,  and  that 
it  may  cause  giantism  or  dwarfism,  and  that  sometimes  it 
may  be  the  seat  of  a  tumor,  which  causes  blindness  or  intra- 
cranial  trouble. 

Ordinarily,  the  pituitary  is  not  credited  with  being  much 
concerned  with  the  "every-day"  troubles  which  come  up  in 
the  routine  of  the  general  practitioner;  yet  it  is  an  impor- 
tant part  of  the  endocrine  system,  and  a  factor  in  the  regu- 
lation of  any  dissimilar  functions. 


200  PRACTICAL  ORGANOTHERAPY 

The  Pituitary-Gonad  Relation.  We  know  that  the  pitui- 
tary gland  has  much  to  do  with  gonad  function,  for  the 
Froehlich  syndrome,  or  dystrophia  adiposo-genitalis,  is  es- 
sentially the  result  of  hypopituitarism.  Therefore,  we  may 
presume  that  a  part  of  the  duties  devolving  on  the  pituitary 
are  the  initiation  or  maintenance  of  sex  gland  development 
and  activity  and,  too,  that  asexualism  and  hypo-ovarism 
may  have  a  pituitary  element  also. 

There  is  a  strange  relationship  between  the  glands  of 
internal  secretion,  which  causes  many  of  them  to  assist 
one  another  under  certain  conditions  of  disability.  Per- 
haps the  best  known  of  these  vicarious  interventions  is  the 
faculty  possessed  by  the  thyroid  of  changing  its  functional 
routine  in  order  to  "help  out"  the  conditions  due  to  ovarian 
insufficiency.  Recall,  for  example,  the  comparative  fre- 
quency of  thyroid  enlargement  at  puberty  when  ovarian 
activity  is  beginning,  and  especially  the  tendency  to  goitre 
in  young  girls  whose  menstrual  functions  are  not  properly 
initiated.  Again,  thyroid  changes  are  not  uncommon  early 
in  pregnancy,  and  one  of  the  accepted  reasons  is  the  fact 
that  during  pregnancy  the  ovarian  functions  are  largely  in 
abeyance  and,  rightly  or  wrongly,  the  thyroid  may  be  at- 
tempting to  render  uncalled  for  assistance. 

In  like  manner,  the  pituitary  gland  may  feel  itself  called 
upon  to  increase  its  service  to  the  organism  under  similar 
circumstances,  for  we  have  seen  that  both  the  thyroid  and 
the  pituitary  are  known  factors  in  the  establishment  and 
regulation  of  ovarian  function.  In  such  an  event,  the  pitui- 
tary may  become  engorged  or  hyperemic  and  thus  may 
enlarge  itself  temporarily  in  order  to  accomplish  the  larger 
service  demanded  of  it,  and  since  the  pituitary  is  fitted  into 
a  bony  cup  (the  sella  turcica)  at  the  base  of  the  skull,  its 
enlargement,  no  matter  if  only  slight,  may  cause  an  annoy- 
ing pressure  headache.  As  soon  as  pituitary  or  pituitary 
and  ovarian  feeding  is  instituted,  or  as  soon  as  the  ovarian 
function  is  reestablished,  the  necessity  for  this  pituitary  en- 
largement or  engorgement  is  removed  and  the  headache 
ceases. 

"Pituitary  headache,"  then,  is  not  an  unusual  accompani- 
ment of  ovarian  difficulties,  especially  during  the  day  or 
days  just  prior  to  menstruation,  particularly  if  delayed  or 
abnormal,  and  its  treatment  consists  in  reducing  the  neces- 
sity for  this  vicarious  activity  by  suitable  organotherapy. 
This  explains  why  Thyro-Ovarian  Co.  (Harrower) — corpus 
luteum  and  ovarian  substance  plus  suitable  small  doses  of 


PITUITARY  DYSFUNCTION  201 

thyroid  and  total  pituitary  gland — is  more  effective  in 
amenorrhea,  dysmenorrhea  and  the  neuroses  of  hypo-ovar- 
ism  than  single  gland  medication  alone.  It  also  explains  its 
efficiency  in  controlling  this  type  of  headache  which  we  will 
now  proceed  to  enlarge  upon  a  little  further. 

Pituitary  Headaches.  In  the  April,  1921,  number  of 
Southern  Medicine  and  Surgery,  Hodges  writes  briefly  and 
pointedly  on  the  subject  of  pituitary  cases  exhibiting  head- 
aches. He  calls  attention,  first,  to  the  symptoms  which 
these  patients  display.  Whether  apparently  well-developed 
or  poorly  nourished,  they  usually  show  signs  of  depression, 
either  physical  or  mental.  They  are  easily  exhausted  from 
effort  or  exercise,  are  likely  to  be  forgetful  and  mentally 
sluggish.  Occasionally,  they  yawn  rather  continuously  and 
feel  sleepy  or  "dopey,"  are  without  initiative,  and  inclined 
to  be  irritable. 

Children  suffering  from  this  condition  are  likely  to  be 
"backward"  and  will  probably  manifest  deficient  moral  qual- 
ities. 

These  patients  sometimes  exhibit  too  much  or  too  little 
growth  of  hair  over  the  body,  or  irregular  distribution  of 
the  same.  In  the  male  there  is  a  curious  manifestation  of 
female  characteristics,  and  rice  versa  in  the  female.  The 
bones  also  show  changes,  and  are  either  long  or  broad,  de- 
pending upon  the  age  when  the  metabolism  was  disturbed. 
There  may  be  obesity,  constipation,  and,  in  women,  amenor- 
rhea. 

Cases  where  this  "headache"  is  present  manifest  many 
of  the  signs  mentioned  but  the  cephalalgia  is  the  predomi- 
nating characteristic,  and,  as  Hodges  says,  "this  symptom 
is  really  the  sentinel  to  give  the  alarm  in  the  approaching 
or  complete  dysfunction  of  the  pituitary  gland.  Great  im- 
portance should  be  attached  to  it,  for  appropriate  pituitary 
therapy  at  this  time,  carefully  followed,  obtains  the  most 
satisfactory  results." 

He  calls  attention  to  the  pluriglandular  aspect  of  the 
disorder  in  the  following  words:  "In  studying  these  cases 
it  is  always  wise  to  observe  carefully  whether  or  not  there 
may  be  other  glands  involved  at  the  same  time,  for  some 
of  these  may  be  stimulators  of  the  pituitary  function,  or 
may  be  acting  independently,  or  in  association  with  the  dys- 
function of  the  pituitary.  It  is  hoped  that  practitioners, 
by  noting  these  facts,  may  be  enabled  to  diagnose  some 
hitherto  obscure  headaches,  and  especially  to  recognize  this 
symptom  as  the  precursor  of  other  developments  that  may 


202  PRACTICAL  ORGANOTHERAPY 

follow;  for  the  important  point  is  that  early  recognition  of 
pituitary  disease,  of  which  this  'headache'  symptom  is  usu- 
ally the  first  signal  of  danger,  is  the  only  scientific  and  suc- 
cessful guarantee  for  its  probable  remedial  relief." 

Clinical  Experiences:  I  have  had  enough  clinical  returns 
from  the  application  of  the  foregoing  suggestions  to  estab- 
lish very  decidedly  the  therapeutic  possibilities  in  this  type 
of  headache,  and  to  connect  the  subject  incontrovertibly 
with  the  ovarian  functions.  I  recall  a  case  of  obesity,  re- 
ferred to  by  me  for  treatment  to  a  local  physician.  The 
associated  headache,  ovarian  disorder  and  other  findings 
prompted  an  organotherapy  which  not  merely  cured  a  head- 
ache of  years'  standing,  but  in  six  or  seven  months  favored 
a  loss  of  eighty  pounds  of  superfluous  adeps. 

Again,  I  was  told  at  our  last  meeting  of  the  California 
State  Society  (at  Coronado,  May,  1921)  of  a  woman  who 
had  had  a  headache  for  ten  years.  Not  a  tendency  to  head- 
ache, or  even  frequent  headaches,  but  an  unending,  uncon- 
trollable headache.  It  was  found  to  be  aggravated  in  con- 
nection with  a  disturbed  ovarian  function,  evidently  orig- 
inated in  relation  to  a  dysovarism  years  before  and,  scien- 
tifically or  unscientifically,  the  patient  was  given  Thyro- 
Ovarian  Co.  (Harrower)  for  3  or  4  months  and  was  cured — 
not  merely  benefited — and  for  many  months  she  has  had 
no  headache  at  all. 


SECTION  V.     CHAPTER  7 
ASEXUALISM  AND  STERILITY  IN  WOMEN 


Sterility  and  asexualism  in  women  are  very  much  more 
common  than  some  may  believe.  While  these  two  conditions 
need  not  necessarily  be  associated  with  one  another,  they 
may  be  given  brief  consideration  together.  Provided  or- 
ganic elements  in  the  former  and  psychic  elements  in  the 
latter  can  be  ruled  out,  it  is  very  probable  that  the  whole 
trouble  is  of  an  endocrine  nature.  The  former  condition 
usually  is  borne  for  years  in  silence,  and  the  latter  often 
seems  too  delicate  a  matter  to  be  taken  up  with  a  physician. 
This  subject  is  none  the  less  of  considerable  clinical  im- 
portance and,  naturally,  is  a  complex  problem.  At  the  close 
of  an  interesting  paper  by  Novak  (Jour.  A.  M.  A.,  Aug.  5, 
1918) ,  this  writer  makes  the  following  pertinent  statement : 


PITUITARY  DYSFUNCTION  203 

"The  reason  for  the  failure  of  this  method  of  attacking  the 
problem  [dilatation  or  local  interference]  lies  in  the  fact 
that  the  sterility  is  most  likely  due  to  a  physiologic  defect 
in  the  endometrium,  that  is,  the  absence  of  some  factor 
essential  to  the  implantation  of  the  ovum.  Here,  again,  we 
hark  back  to  disorders  of  the  internal  secretory  system  as 
the  ultimate  cause.  This,  after  all,  is  the  conviction  borne 
in  on  anyone  who  studies  this  general  problem,  whether  or 
not  he  be  a  ductless  gland  enthusiast  or  'faddist' — the  con- 
viction that  the  day  will  come  when  these  very  numerous 
cases  of  primary  amenorrhea,  primary  dysmenorrhea  and 
sterility,  which  are  associated  with  uterine  hypoplasia,  will 
be  successfully  treated  by  correcting  the  endocrinopathy 
responsible  for  the  uterine  defect." 

The  Endocrine  Causes.  For  the  moment  we  are  concerned 
chiefly  with  one  aspect  only — the  endocrine  aspect — and  the 
remarks  that  have  been  made  elsewhere  (see  "The  Hor- 
mones in  Impotence")  apply  with  just  as  much  force  to 
either  sex.  The  adrenal  glands  exert  the  same  influence 
upon  general  muscular  tone  in  the  male  as  in  the  female; 
and  the  adrenal  cortex  is  just  as  responsible  for  its  share 
in  ovarian  development  as  for  testicular.  The  essential  in- 
fluence of  the  thyroid  is  identical  in  both  sexes,  and  all  that 
has  been  said  in  the  chapter  referred  to  about  the  pituitary 
aspect  of  impotence  applies  with  equal  force  to  both  asex- 
ualism  and  sterility.  It  is  even  believed,  from  clinical  ex- 
perience, that  spermin  is  an  excellent  ovarian  stimulant— 
largely,  it  is  presumed,  because  of  its  known  affinity  for 
the  reproductive  cells  and  because  of  the  fact  that  it  stim- 
ulates muscular  tone  and  that  subtle  something  known  as 
"dynamos",  irrespective  of  sex. 

Thyroid  insufficiency  is  known  to  have  caused  sterility 
and,  too,  thyroid  therapy  is  known  to  have  cured  this  dis- 
order many  times;  hence,  the  thyroid  aspects  of  the  case 
are  worthy  of  consideration,  and  my  Thyroid  Function  Test 
very  properly  may  be  used  to  determine  whether  the  patient 
has  a  well-defined  degree  of  thyroid  apathy  or  not.  It  is 
well  known,  and  there  are  plenty  of  references  in  the  litera- 
ture to  indicate  it,  that  the  thyroid  stimulates  the  ovaries, 
and  Oliver  T.  Osborne,  of  Yale,  has  stated  that  the  thyroid 
gland  is  virtually  an  associate  ovary,  so  intimate  are  the 
two  organs  in  their  correlation  of  function.  We  have  found 
that  amenorrhea  and  asexualism  are  common  in  hypothy- 
roidism,  and  that  thyroid  extract  in  conjunction  with  more 
direct  organotherapy  renders  it  very  much  more  efficient. 


204  PRACTICAL  ORGANOTHERAPY 

Hence,  a  part  of  the  treatment  of  a  sterility  in  which  there 
is  a  thyroid  factor  obviously  is  thyroid  therapy. 

The  Pituitary  Basis  of  Sterility.  It  will  be  recalled  that 
the  pituitary  gland,  as  a  part  of  its  widespread  influence 
upon  the  body,  has  a  control  over  the  development  and  func- 
tioning of  the  sex  glands.  The  typical  case  of  hypopituitar- 
ism,  or  Frohlich's  syndrome,  involves  not  merely  amenor- 
rhea  but  complete  ovarian  insufficiency  with  even  atrophy, 
not  merely  of  the  ovaries  themselves,  but  the  connected 
adnexa.  Infantilism  invariably  involves  the  other  endocrine 
glands,  especially  the  thyroid  and  the  pituitary ;  and  organo- 
therapy is  the  only  hope  in  the  treatment  of  conditions  like 
this.  When  they  are  functional  or  acquired,  the  chances 
naturally  are  very  much  better  than  when  they  have  been 
present  since  childhood  and  there  has  never  been  any  real 
development  of  these  organs,  although  even  in  such  cases 
results  show  that  it  is  well  worth  trying. 

An  Effective  Ovarian  Stimulant.  Pluriglandular  therapy, 
then,  would  seem  to  be  the  most  rational  method  of  treating 
functional  sterility  as  well  as  asexualism.  The  combination 
of  thyroid,  pituitary  and  ovarian  substances,  as  represented 
by  Thyro-Ovarian  Co.  (Harrow  er) ,  not  merely  has  served 
to  regulate  the  abnormal  menses  and  modify  the  neurotic 
and  psychic  manifestations  so  common  in  these  individuals, 
but  actually  has  cured  sterility  in  many  cases.  Dozens  of 
reports  have  come  to  me  either  personally,  by  telephone, 
or  by  letter,  of  cases  in  which  sterility  of  years'  standing 
has  been  changed  to  fecundity  after  as  short  a  period  as 
three  months,  and  practically  all  of  those  cases  discovered 
that  there  were  changes  in  their  sex  manifestations  and 
menstruation  prior  to  the  actual  impregnation.  In  other 
words,  these  results  lend  still  further  emphasis  to  the  neces- 
sity of  applying  organotherapy  in  functional  cases  and  ex- 
pecting results  in  those  cases  in  which  the  fundamental 
cause  is  a  dyscrinism. 

The  following  letter  received  from  a  prominent  gyne- 
cologist is  of  passing  interest :  "I  was  very  much  interested 
to  have  one  of  my  old  patients  report  a  few  days  ago  that 
she  was  41/2  months  pregnant.  She  originally  consulted  me 
last  spring  for  sterility,  having  been  married  two  years.  I 
first  had  her  on  lutein  for  a  number  of  months  with  no  re- 
sult. She  is  a  strong,  healthy  woman  in  every  way  and 
there  was  no  apparent  reason  why  she  should  not  conceive. 
Shortly  before  my  departure  for  France  in  July,  I  put  her 
on  your  Thyro-Ovarian  Co.  with  the  happy  result  that  she 


PITUITARY  DYSOVARISM  205 

became  pregnant  in  September  and  is  now  under  my  care 
for  confinement.  I  am  quite  sure  that  the  gland  stimulus 
she  received  was  the  important  factor  in  bringing  about 
the  desired  condition." 

Reinforcing  Thyro-Ovarian  Therapy.  In  the  experimental 
work  done  in  this  laboratory  in  connection  with  the  develop- 
ment of  the  Gonad  Co.  (Narrower)  mentioned  in  Section  V, 
Ch.  7,  an  effort  was  made  to  develop  simultaneously  a 
similar  formula  for  those  cases  among  women  of  a  more 
severe  character  that  might  not  respond  to  the  usual  Thyro- 
Ovarian  combination.  A  modification  of  this  latter  formula 
was  made  by  adding  a  generous  dose  of  anterior  pituitary 
substance  and  of  spermin,  and  the  resulting  formula,  known 
now  as  Gonad-Ovarian  Co.  (Harrower) ,  was  used  in  a  num- 
ber of  serious  cases,  as,  for  example,  a  case  of  ovarian  in- 
sufficiency in  which  the  menses  had  been  absent  for  six 
years,  a  woman  who  had  been  barren  for  thirteen  years,  and 
a  very  unusual  case  of  infantilism  in  whom  a  psychosis 
complicated  matters.  All  three  of  these  seriously  difficult 
cases  responded  satisfactorily  to  this  formula,  and  since 
those  experimental  days  of  previous  years,  many  hundreds 
of  cases  of  disorderd  endocrine  function,  involving  especially 
the  sex  and  reproductive  capacity,  have  been  treated  in 
this  manner  with  a  sufficiently  large  average  of  success  to  be 
of  great  encouragement  both  to  myself  and  to  many  scores 
of  physicians  who  have  seen  fit  to  write  me  in  enthusiastic 
terms. 

Rule  Out  Coincidental  Causes.  As  in  the  treatment  of 
impotence  in  the  male,  extraordinary  care  must  be  given  to 
the  preliminary  diagnostic  work  in  the  treatment  of  asex- 
ualism,  and  especially  sterility,  in  the  female.  A  careful 
analysis  of  all  the  conditions  present  must  be  made  first. 
When  the  examination  indicates  that  the  woman  is  appar- 
ently normal,  but  perhaps  functionally  and  slightly  anatom- 
ically asexual — with  a  smaller  uterus  than  normal  and, 
perhaps,  some  evidence  of  infantilism — we  have  an  oppor- 
tunity to  apply  organotherapy  with  good  prospects  of  suc- 
cess. However,  organotherapy  is  not  effective  if  a  woman 
has  had  a  specific  infection  of  the  Fallopian  tubes  and  their 
lumina  have  been  occluded,  for  here  the  sterility  is  purely 
mechanical.  Again,  if  the  woman  is  luetic  and  consequently 
is  subject  to  frequent  miscarriages,  naturally  the  syphilis 
must  be  remedied  before  normal  conditions  can  be  reestab- 
lished, which  will  allow  a  pregnancy  to  run  to  full  term.  A 
mechanical  factor  in  the  uterus  and  especially  the  endome- 


206  PRACTICAL  ORGANOTHERAPY 

trium,  which  may  prevent  impregnation  or  the  nesting  of 
the  impregnated  ovum  and  its  development,  is  on  a  par 
with  the  mechanical  occlusion  of  the  tubes  already  men- 
tioned. Under  such  circumstances  organotherapy  is  fore- 
doomed to  failure,  and,  obviously,  causes  of  this  kind  must 
be  ruled  out  first.  Some  other  factors  which  may  militate 
against  our  success  in  the  treatment  of  this  condition  de- 
serve mention,  even  though  briefly.  An  infection  of  the 
vaginal  tract  which  causes  an  abnormally  acid  secretion 
must  be  remedied  before  an  associated  hypo-ovarism,  or 
dyscrinism  involving  the  ovaries  and  other  associated 
glands,  is  treated ;  for  in  such  cases  while  the  organotherapy 
may  be  indicated  and,  indeed  may  be  efficacious,  this  chem- 
ical factor  lessens  the  chances  of  the  results  desired. 

The  Influence  of  Organotherapy  on  the  Libido.  It  has 
been  observed  many  times,  clinically,  that  ovarian  therapy 
stimulates  the  ovaries  to  a  better  menstrual  function,  and 
it  is  believed  that,  with  this  capacity  of  facilitating  a  more 
normal  menstrual  service  to  the  organism,  the  other  func- 
tions of  the  ovaries  are  simultaneously  encouraged.  I  have 
repeatedly  seen  cases  of  ovarian  insufficiency,  in  which 
amenorrhea  was  the  rule,  recover  also  from  two  other 
usually  associated  manifestations — asexualism,  or  a  lessened 
or  lost  sex  capacity,  and  sterility.  Sexual  apathy,  or  lack  of 
libido,  may  be  a  purely  endocrine  proposition  and  deserves 
consideration  and  treatment  from  this  standpoint.  We  have 
seen,  for  instance,  that  in  myxedema  (hypothyroidism) , 
Frohlich's  dystrophia  adiposo-genitalis  (hypopituitarism) 
this  reaction  is  likely  to  be  lost,  and  also  that  it  may  be 
lessened,  almost  entirely  by  ovarian  insufficiency;  hence,  a 
treatment  embodying  these  three  principles,  added  to  advice 
in  regard  to  fundamentals,  is  likely  to  be  efficacious  and 
indeed  has  been  many  times,  and  the  use  of  preparations  of 
the  character  under  discussion  here  offers  better  possibil- 
ities of  success  than  any  other  measure  that  I  know  of. 

This  brings  us  to  a  point  of  diagnostic  value  which  ampli- 
fies the  position  outlined  in  Section  II,  Chapter  6,  "Diag- 
nostic Organotherapy" :  If  a  woman  has  a  normal  menstrua- 
tion and  a  normal  sex  reaction  and  is  still  sterile,  the 
chances  are  that  the  obstacle  is  an  anatomical  one,  and  not 
likely  to  be  amenable  to  organotherapy. 

If,  on  the  other  hand,  there  is  other  evidence  (besides 
the  sterility)  of  ovarian  insufficiency  as  manifested  by 
amenorrhea  and  asexualism,  the  chances  for  clinical  results 
are  better,  because  it  is  likely  under  such  circumstances  that 


PITUITARY  DYSOVARISM  207 

the  ovarian  endocrine  complex,  as  a  whole,  is  deficient;  in 
other  words,  that  there  is  pluriglandular  insufficiency,  in- 
volving not  merely  the  ovaries,  but  those  glands  which  en- 
courage and  help  to  maintain  the  service  to  the  body. 

In  spite  of  the  inherent  difficulties  in  considering  and 
treating  this  class  of  cases,  and  especially  the  many  oppor- 
tunities for  failure  resulting  from  the  ignoring  of  over- 
looked factors  of  the  character  already  mentioned  with 
emphasis,  I  have  seen  personally  enough  individuals  with 
light  in  their  eyes  and  enthusiasm  in  their  tone  to  be  con- 
verted for  all  time  to  the  real  possibilities  of  this  method. 
I  have  read  scores  of  reports  confirming  my  attitude  and  I 
have  more  confidence  in  this  particular  present-day  method 
of  treating  hypogonadism  than  I  ever  had  before  I  made 
myself  acquainted  with  the  importance  of  the  relations  of 
the  endocrine  glands  and  the  control  that  many  of  them 
exert  upon  one  another. 

Routine  Treatment  Outlined.  My  method  in  treating  these 
cases  of  sterility  and  asexualism  is  first  to  assure  myself 
that  there  are  no  extraneous  factors  of  a  non-endocrine 
character.  All  of  the  points  already  mentioned  must  be 
carefully  gone  over.  The  husband  must  be  examined,  and 
only  when  the  case  is  evidently  of  an  endocrine  character 
is  organotherapy  indicated. 

The  formulas  known  as  Gonad^Ovarian  Co.  (Harrower) 
should  be  given  for  several  weeks  and  perhaps  months,  for, 
naturally,  organotherapy  in  long-standing  conditions  is  in 
the  nature  of  an  educative  factor  and  such  measures  as 
this  take  time.  This  formula,  Gonad-Ovarian  Co.  (Har- 
rower) is  best  given  in  the  cyclic  manner  referred  to  in  the 
previous  chapter,  in  the  expectation  of  exerting  the  utmost 
influence  upon  the  ovaries  at  their  height  of  functional 
activity;  consequently,  at  the  onset  of  menstruation,  the 
preparation  may  be  omitted  for  several  days.  I  am  in  the 
habit  of  advising  a  break  of  ten  days  commencing  at  the 
beginning  of  the  flow;  then  giving  one  dose  three  times 
a  day  during  the  next  ten  days,  and  doubling  this  dose  for 
ten  days  prior  to  the  expected  flow.  This  is  then  repeated 
for  at  least  three  or  four  periods. 

In  individuals  in  whom  there  is  no  menstruation  nor 
molimen,  the  same  step-ladder  method  may  be  followed, 
the  month  being  divided  arbitrarily  into  three  equal  parts ; 
and  as  soon  as  there  is  the  slightest  evidence  of  discomfort 
in  the  nature  of  a  molimen,  or  ever  so  small  a  flow,  the 
remedy  is  omitted  for  the  short  period  thereafter  and  then 


208  PRACTICAL  ORGANOTHERAPY 

pushed ;  i.  e.,  the  dose  is  doubled,  for  a  week  or  ten  days 
prior  to  the  expected  periodic  manifestation  which  later  on 
may  establish  itself  and  serve  as  an  indicator  as  to  when  to 
modify  the  dosage. 


SECTION  V.    CHAPTER  8 
GALACTAGOGUE  ORGANOTHERAPY 


The  appreciation  of  the  factors  responsible  for  the  estab- 
lishing and  maintenance  of  satisfactory  lactation  is  ob- 
viously of  fundamental  importance  to  human  welfare  and 
of  much  practical  value  in  general  practice. 

Deficient  milk  production — agalactia  or  hypogalactia — is 
common  enough,  and  aside  from  the  influence  it  may  have 
upon  infant  health  and  mortality,  it  also  has  a  very  definite 
physiological  relation  to  pelvic  disturbances  in  the  mother, 
for  nursing  is  also  a  normal  factor  in  ovaro-uterine  physiol- 
ogy, and  those  who  will  not  or  cannot  nurse  their  children 
often  have  to  suffer  for  it  later  on. 

There  are  no  very  well  known  galactagogue  remedies. 
The  administration  of  plenty  of  milk  and  cream  and  other 
dietetic  care  usually  constitutes  the  best  that  we  can  do.  We 
feed  cotton-seed  cakes  to  our  cattle  because  gossypiin  is  a 
recognized  galactagogue,  yet  this  principle  is  rarely  used 
in  medicine.  Various  malt  preparations  and  special  foods 
are  recommended,  all  of  which  act  upon  this  function  indi- 
rectly. 

Hormone  Control  of  the  Mammae.  Mammary  develop- 
ment and  secretion  seem  to  be  definitely  under  the  control 
of  hormone  influences.  The  ovarian  hormone  has  been  shown 
to  stimulate  mammary  development.  A  hormone  produced 
in  the  fetus  itself  causes  the  formation  of  milk,  the  placenta 
also  has  something  tangible  to  dp  with  this,  and  finally  the 
absence  or  removal  of  these  various  factors  causes  a  stop- 
page of  this  function.  With  this  in  mind  it  should  be  pos- 
sible artificially  to  bring  about  desired  stimulation  by  some 
form  of  organotherapy.  With  the  well-established  prin- 
ciple of  hormone  stimulation  in  mind,  it  was  natural  to  try 
the  administration  of  mammary  substance,  and  some  indu- 
bitable results  have  followed  this  procedure.  It  is  now 
established  that  mammary  extract  is  a  galactagogue.  Some 
experimental  work  upon  cows,  at  Cornell  University,  has 


GALACTAGOGUE  THERAPY  209 

also  demonstrated  that  the  pituitary  gland  contains  within 
it  an  active  galactagogue  principle,  and  a  number  of  records 
in  the  literature  of  agriculture  as  well  as  medicine  indicate 
that  its  use  for  this  purpose  is  at  least  feasible. 

Further,  and  most  important,  the  placenta  has  been  found 
not  merely  to  be  an  organ  of  internal  secretion  but  to  be  a 
means  of  artificially  increasing  a  deficient  supply  of  milk. 
It  is  interesting  to  know  that  quite  recently  a  French  scien- 
tist, deKervily,  has  shown  that  certain  vacuolated  cells 
normally  found  in  the  placenta  are  actually  secretory  ele- 
ments and  presumably  similar  to  the  internal  secretory  cells 
of  the  pancreas,  which  are  found  in  the  islets  of  Langer- 
hans. 

Placenta  Substance  as  a  Galactagogue.  The  original  use 
of  this  measure  seems  to  be  very  old,  and  unquestionably,  is 
based  upon  the  observation  that  domestic  animals,  almost 
without  exception,  manifest  a  remarkable  and  uniform  in- 
stinct to  devour  the  placenta  as  soon  as  it  is  delivered.  It 
is  clear  that  these  animals  do  not  eat  the  placenta  through 
hunger  or  instinct  to  keep  the  nest  clean,  for  it  will  be  re- 
called that  the  cow  is  herbivorous  and  has  no  nest! 

Some  very  practical  and  interesting  experiences  were  ob- 
tained by  Dr.  Bertha  Van  Hoosen,  of  Chicago,  who  made  a 
number  of  experiments  at  the  Mary  Thompson  Hospital 
( Woman's  Med.  Jour.,  Dec.,  1916) .  Thirty  grains  of  desic- 
cated placenta  were  given  daily  to  a  series  of  cases  in  six 
doses  an  hour  apart.  The  first  report  was  a  complaint  from 
the  nurses — the  patients  had  so  much  milk  that  it  was  a 
burden  to  keep  the  breasts  empty !  A  case  is  mentioned  in 
which  16  ounces  of  milk  were  removed  after  the  infant  had 
taken  all  it  would.  Three  others  had  6  ounces  removed 
immediately  after  nursing.  A  fifth  patient  had  8  ounces, 
and  a  sixth  had  4  ounces  removed  under  like  circumstances. 
Generous  quantities  of  superfluous  milk  were  obtained  with- 
out depriving  the  child,  the  only  object  being  to  secure 
comfort  for  the  mother.  Tabulated  findings  indicate  that 
the  infants  of  placenta-fed  mothers  maintained  or  increased 
their  birth  weight  at  the  end  of  the  second  week,  whereas 
comparisons  between  a  large  number  of  treated  and  un- 
treated indicated  that  the  average  loss  during  the  first 
week  was  9*/2  ounces,  whereas  in  the  cases  where  desiccated 
placenta  was  used,  the  average  loss  was  only  S1/^  ounces 
for  the  first  week.  During  the  second  week,  the  average 
gain  was  50  per  cent,  greater  than  in  the  untreated  in- 
fants, the  conclusion  being  that  the  "administration  of 

14 


210  PRACTICAL  ORGANOTHERAPY 

desiccated  placenta  produces  an  early  and  gradual  stimula- 
tion of  the  secretion  of  milk  and  no  other  by-effects." 

R.  T.  Frank,  of  New  York  (Jour.  Cancer  Research,  2, 
1917),  determined  that  placental  extracts  "experimentally 
stimulate  the  breasts,  increasing  the  area  and  developing 
the  ducts,  acini  and  nipples."  S  .W.  Bandler,  also  of  New 
York,  includes  mammary  extract  and  placental  substance 
among  "the  valuable  opotherapeutic  products."  (Endo- 
crinology, June,  1919.)  E.  L.  Cornell,  of  Chicago,  reports 
some  experiences  with  the  galactagogue  influence,  especially 
the  indirect  effect  upon  the  infants.  Of  the  cases  studied, 
87  per  cent,  began  to  gain  on  the  4th  or  5th  days,  as  against 
69  per  cent,  of  those  whose  mothers  did  not  take  the  ex- 
tract. Of  the  treated  cases,  44  per  cent,  regained  the  birth 
weight  before  leaving  the  hospital,  as  against  only  24  per 
cent,  of  the  latter.  Very  little  attention  has  been  paid  to 
statistical  studies  of  this  character,  and  these  figures  are 
an  additional  encouragement  to  those  who  have  been  urging 
this  matter  for  years. 

Much  experimental  work  has  been  done,  and  it  has  been 
found  that  preparations  of  this  character  not  only  exert  a 
tonic  involuting  influence  on  the  postpartum  uterus,  but 
according  to  Ercole  Cova,  an  Italian  investigator  (Anna. 
Ostet.  e  Gin,  Sept.,  1915),  placenta  extracts  may  be  used 
therapeutically  in  the  treatment  of  hypoplastic  uterus,  for 
it  seems  that  there  is  a  principle  in  the  placenta  that  causes 
growth  in  the  uterus,  both  during  pregnancy  and  in  abnor- 
mal infantile  cases.  This  particular  phase  of  organotherapy 
indeed  seems  quite  promising. 

A  Pluriglandular  Galactagogue  Formula.  For  a  number 
of  years,  I  have  been  recommending  a  formula  embodying 
the  three  glandular  preparations  mentioned  here —  mam- 
mary substance  for  its  hormone  stimulant  effect  upon  the 
mammary  glands,  placenta  for  its  indubitable  galactagogue 
effect,  and  pituitary  gland  for  its  possible  benefit  to  milk 
production  and  its  associated  value  as  a  general  and  uterine 
tonic.  This  formula,  under  the  name  Placento-Mammary 
Co.  (Harrower),  has  been  used  for  some  time  with  quite 
unusual  success  when  there  has  been  a  serious  reduction  of 
the  amount  of  milk  secreted;  but  it  is  more  rational  as  a 
prophylactic  and  is  recommended  as  a  routine  procedure 
following  labor.  The  initial  dose  is  ten  grains  at  each 
of  three  meals  daily  for  ten  days  or  two  weeks,  thereafter 
continuing  the  administration  of  one  dose  three  times  a  day 
for  several  weeks. 


GALACTAGOGUE  THERAPY  211 

There  also  seems  to  be  some  relation  between  nursing, 
the  administration  of  placenta  extract,  and  early  menstru- 
ation after  pregnancy.  I  recall  a  recent  inquiry  from  a 
colleague,  who  asked  if  the  Placento-Mammary  Co.  pre- 
vented menstruation.  I  was  noncommittal  in  my  reply, 
because  I  really  did  not  know.  I  said  that  it  was  supposed 
to  favor  the  establishment  of  normal  postpartum  condi- 
tions, including  the  milk  supply  and  uterine  involution.  I  re- 
marked that  menstruation  during  lactation  was  not  normal, 
and  was  not  surprised  to  learn  the  following  case  report: 
A  3-para  who  had  had  difficulty  in  nursing  her  other  chil- 
dren, and  who  has  always  menstruated  five  or  six  weeks 
after  delivery  and  thereafter  fairly  regularly,  had  been 
given  the  Placento-Mammary  Co.  to  obviate  the  expected 
difficulty  with  the  nursing  if  that  were  possible.  The  re- 
sponse was  splendid  and  there  was  enough  milk  and  to 
spare,  but  to  the  surprise  of  the  patient  she  did  not  mens- 
truate for  over  five  months,  during  all  of  which  period  she 
was  satisfactorily  nursing  her  baby. 

The  Control  of  Galactorrhea.  Some  time  ago,  among  the 
queries  received  at  my  office  was  one  asking  whether  there 
is  anything  in  organotherapy  which  could  stop  the  func- 
tioning of  the  mammary  glands,  the  case  in  question  being 
that  of  a  woman  who  ever  since  her  first  pregnancy  had 
had  a  continuous  flow  of  milk  which  could  not  be  stopped 
either  by  belladonna  or  any  other  means.  My  reply  was 
more  or  less  as  follows :  The  mammse  are  definitely  antago- 
nized by  the  ovaries  and  vice  versa.  Mammary  therapy 
many  times  has  relieved  menorrhagia  and  pelvic  congestion 
due  to  ovarian  irritability.  On  the  other  hand,  ovarian  feed- 
ing is  contraindicated  during  lactation,  and,  too,  the  mam- 
mary activities  are  greatest  when  ovarian  function  is  in 
abeyance.  The  excellent  thesis  of  Schil  (Nancy,  1912) ,  con- 
cerning mammary  evolution  and  function  is  a  comprehen- 
sive study  of  the  subject.  An  abstract  of  it  will  be  found 
in  my  book,  "Practical  Hormone  Therapy,"  pages  371-3. 

Bearing  these  facts  in  mind  we  might  properly  attempt 
to  antagonize  mammary  hyperactivity  by  ovarian  feeding 
or  corpus  luteum.  It  is  theoretical,  for  I  know  of  no  case 
in  which  this  method  has  been  tried ;  but,  at  least,  it  is  not 
unreasonable.  I  would  suggest  fairly  heavy  dosage  of 
desiccated  ovarian  substance  for  a  month  or  more;  and  at 
the  same  time  I  would  use  the  usual  mechanical  pressure 
by  the  bandage  and  atropin  as  well,  giving,  say,  1-200  of  a 
grain  of  atropin  sulphate  by  mouth  three  times  a  day. 


212  PRACTICAL  ORGANOTHERAPY 

SECTION  V.     CHAPTER  9 
THE  CONTROL  OF  MENORRHAGIA 


Menorrhagia  and  ovarian  irritability  are  often  treated 
successfully  with  mammary  substance  and  the  therapeutic 
effects  of  this  unusual  preparation  indicate  that  it  is  "an 
antiovarian  remedy."  Some  study  of  the  physiology  and 
clinical  experiences  with  mammary  extract  will  be  an  ad- 
vantage. 

Whether  or  not  the  mammary  glands  are  really  glands 
of  internal  secretion  is  a  moot  question.  Some  say  "Yes" 
and  prove  it  in  a  fairly  intelligible  manner,  while  others 
say  "No" — on  general  principles!  Certain  facts  indicate, 
however,  that  these  glands  deserve  at  least  to  be  considered 
from  this  viewpoint,  for  the  mammse  are  under  hormone 
control  and  they  contain  within  their  structure  a  substance 
which  remains  in  the  desiccated  substance  and  which,  when 
used  as  a  remedy,  exerts  a  definite  action  (homostimulant) 
upon  the  mammse  themselves,  as  well  as  upon  other  remote 
organs. 

The  Hormone  Control  of  the  Mammary  Glands.  A  num- 
ber of  common  experiences  remind  us  of  the  hormone  rela- 
tions of  the  mamma? :  It  is  a  well-established  fact  that  the 
operation  of  spaying  dairy  cows  at  the  time  of  their  great- 
est flow  of  milk  has  a  distinct  lengthening  influence  upon 
the  lacteal  period.  Additional  emphasis  is  lent  by  the  fact 
that  the  function  of  ovulation  is  retarded  and  sometimes 
entirely  stopped  during  prolonged  lactation,  presumably  be- 
cause in  this  stage  of  mammary  activity  ovarian  activity 
is  antagonized  in  a  greater  or  less  degree,  due,  as  some  will 
have  it,  to  an  associated  increased  elaboration  of  the  in- 
ternal secretion  of  the  mammary  glands.  It  is  also  well 
known  that  the  supply  of  milk  is  considerably  lessened  soon 
after  a  new  conception  takes  place. 

Still  another  aspect  to  this  subject  is  worthy  of  passing 
comment :  I  have  frequently  noticed  a  relationship  between 
very  large  mammary  development  and  scanty  menstruation. 
In  a  paper  entitled  "Mammary  Therapeutics ;  The  Mammse 
as  Glands  of  Internal  Secretion"  ( Woman's  Med.  Jour.,  Mar., 
1914),  I  called  attention  to  this,  and  it  was  remarked  that 
while  this  is  by  no  means  always  the  case,  it  points  at  least 
to  an  antagonism  between  the  mammse  and  ovaries.  Late 
in  1918,  Oliver  T.  Osborne,  of  Yale  University,  wrote,  "Girls 


MENORRHAGIA  213 

with  very  large  mammary  glands  may  have  long  periods  of 
amenorrhea  without  pregnancy,  or  they,  have  very  irregular 
or  scanty  menstruation." 

Most  of  these  findings  indicate  that  the  breasts  are  re- 
lated in  some  way  to  hormone  influences,  i.  e.,  they  may 
exert  some  control  through  an  internal  secretion  upon  the 
ovaries  or  other  organs.  Further  proof  of  this  activity  will 
be  forthcoming,  for,  as  will  be  seen  shortly,  this  antagonism 
is  put  to  good  use  in  therapeutics. 

Origin  and  Clinical  Value.  Numerous  references  to  the 
use  of  mammary  extracts  show  conclusively  that  they  have 
caused  decided  therapeutic  effects,  and  at  the  same  time 
emphasize  the  importance  of  what  still  must  be  called  a 
much  neglected  field  of  therapeutics.  In  fact  this  is  getting 
to  be  a  well-established  part  of  organotherapy,  despite  de- 
nials which  still  are  heard  occasionally.  The  truth  is,  that 
mammary  substance  is  one  of  our  best  measures  for  an- 
tagonizing ovarian  activity  and  lessening  functional  con- 
gestion in  the  pelvis. 

Mammary  extract  is  produced  from  the  carefully  desic- 
cated parenchyma  of  the  udders  of  cows,  goats  or  ewes, 
and  is  prepared  in  dry  form  with  the  precautions  customary 
in  the  manufacture  of  effective  organotherapeutic  prepara- 
tions ;  and  whatever  the  principle  may  be  that  is  the  cause 
of  the  therapeutic  activity  of  this  extract,  it  is  evidently  not 
destroyed  when  passing  through  the  stomach.  Incidentally, 
much  work  has  been  done  with  soluble  mammary  extracts 
given  hypodermically,  but  they  have  been  virtually  dis- 
carded in  clinical  practice  because  of  the  local  pain  and  in- 
duration which  so  often  follows  such  injections. 

The  Control  of  Menorrhagia.  Because  of  the  antagonism 
between  the  mammaB  and  the  ovaries,  it  was  natural  that 
mammary  extract  should  be  used  in  the  attempt  to  over- 
come the  results  of  excessive  ovarian  activity.  Among  the 
conditions  which  have  been  classed  under  this  head  are 
menorrhagia  with  increased  uterine  congestion,  uterine 
hypertrophy  and  fibroid  degeneration,  as  well  as  certain 
conditions  in  which  there  is  an  increased  degree  of  func- 
tional ovarian  activity,  including  nymphomania,  etc. 

A  number  of  investigators  have  used  this  method  to  pro- 
duce uterine  depletion  and  to  control  hemorrhages  shown  to 
be  due  to  functional  causes  as  distinguished  from  those 
of  organic  origin,  such  as  the  presence  of  foreign  bodies  in 
the  uterus,  polypi,  placental  remains,  cancer,  etc.  Osborne 
stated  very  recently  that  "profuse  menstruation  in  girls 


214  PRACTICAL  ORGANOTHERAPY 

.  .  .  may  be  prevented  by  the  administration  of  mammary 
substance."  In  another  place,  the  same  writer  says,  "A 
profuse  or  too  frequent  menstruation,  where  there  is  no 
pathological  excuse,  especially  in  young  girls,  may  be  cor- 
rected by  feeding  mammary  extracts." 

Pochon  has  used  mammary  substance  and  recommends 
it  for  its  decided  anti-hemorrhagic  influence  (however,  it  is 
not  a  styptic  by  any  means)  and  calls  attention  to  the  fact 
that  while  mammary  extract  tends  to  cause  uterine  deple- 
tion, ovarian  extracts  have  an  entire  opposite  tendency, 
causing  an  increased  uterine  blood  supply.  Battuaud  indi- 
cates that  this  form  of  medication  has  proved  valuable  in 
the  control  of  menorrhagia  in  young  girls,  just  as  it  has 
been  found  serviceable  in  metrorrhagia  of  the  climacteric. 
Congestive  conditions  of  the  ovary  resulting  from  inflama- 
tion  of  the  adnexa  and  other  causes  may  be  reduced  in 
this  manner,  although,  of  course,  the  influence  is  more  me- 
chanical— i.  e.,  decongestion  is  brought  about  in  a  chemical 
way  and  there  is  no  particular  action  on  the  infective  pro- 
cess. In  other  words,  mammary  extract  is  a  valuable 
adjunct  to  treatment.  Dalche,  Jayle,  Pozzi  and  other 
French  gynecologists  have  expressed  themselves  freely  as 
convinced  of  the  efficacy  of  this  method.  The  advantage 
of  this  depletion  is  obvious  in  pelvic  congestion  of  varied  ori- 
gin. It  has  been  used  in  severe  pelvic  pain  due  to  infection 
(and  consequent  congestion),  and  even  in  uterine  cancer 
with  constant  oozing  where  results  have  been  so  good — 
stoppage  of  all  flow  and  reduction  of  the  bad  odor — that 
the  patient  has  anticipated  a  cure,  though,  of  course,  this  is 
not  possible.  Luncz,  in  his  interesting  monograph,  has 
gathered  a  number  of  reports  of  benign  cases  in  which 
mammary  opotherapy  caused  an  entire  cessation  of  severe 
uterine  hemorrhage  in  persons  of  widely  varying  age. 

Other  writers  have  gone  further,  among  them  Forgue 
and  Massabuan,  who,  besides  demonstrating  clinically  the 
anti-hemorrhagic  action  of  this  preparation,  have  shown 
experimentally  that  at  the  menopause  there  frequently  is 
an  obvious  increase  in  the  corpora  lutea  with  hypertrophy 
of  these  cells.  They  presume  that  the  hemorrhages  so 
common  at  this  time  may  be  due  to  two  causes:  Tem- 
porary increased  production  of  the  luteal  hormone,  and  an 
associated  decrease  in  the  production  of  its  antagonist — the 
mammary  hormone — resulting,  of  course,  from  the  usual 
retrogressive  changes  expected  in  the  mammae  at  this  per- 
iod. This  harmonizes  entirely  with  the  facts  previously 


MENORRHAGIA  215 

collated  here,  and  is  further  evidence  of  the  soundness  of 
the  position  that  I  have  taken  for  years  and  established  to 
my  own.  personal  satisfaction,  i.  e.,  that  this  particular  anti- 
hemorrhagic  influence  of  mammary  substance  is  indeed  a 
reality  in  many  cases. 

Preparations  Containing  Mammary  Substance.  Among 
the  formulas  made  in  The  Harrower  Laboratory  are  three 
containing  mammary  gland.  The  first  of  these,  No.  3, 
Placento-Mammary  Co.  (Harroiver),  is  used  chiefly  as  a 
galactagogue  where  the  homostimulant  effect  of  the  remedy 
supplements  the  more  active  effect  of  desiccated  placenta. 
The  subject  is  given  full  consideration  in  Chapter  8  of  this 
Section. 

Another  mammary  combination,  No.  38,  Mamma-Ovary 
Co.  (Harrower),  is  used  in  menstrual  difficulties  of  an 
ovarian  character  which  lean  toward  an  excessive  flow. 
This  class  of  cases  is  hardly  to  be  called  menorrhagia,  since 
the  flow  usually  is  net  particularly  serious.  In  these  cases, 
ordinarily  occurring  in  girls  and  quite  young  women  (in 
contradistinction  to  the  real  menorrhagia  of  older  women, 
especially  at  the  menopause)  the  flow  lasts  six,  seven  or 
more  days  and  may  recur  at  shorter  intervals  than  is  nor- 
mal. Here  there  is  not  so  much  a  condition  of  ovarian  irri- 
tability or  excess  as  a  dysovarism  which  is  accompanied 
by  pelvic  congestion  and  the  minor  form  of  menorrhagia 
just  mentioned.  Because  there  is  a  decided  dysfunction  of 
the  ovaries,  the  mammary  substance  is  combined  with  a 
thyro-ovarian  combination ;  and  despite  the  known  relations 
of  these  glands,  the  body  seems  to  be  able  to  use  the  differ- 
ing stimuli  simultaneously.  In  cases  of  dysovarism  which 
tend  toward  a  prolonged  or  too  frequent  flow,  this  formula 
may  be  superior  to  the  more  frequently  used  Thyro-Ovar- 
ian  Co.  (Harrower),  which  is  considered  elsewhere. 

Still  another  formula  of  this  type  deserves  to  be  men- 
tioned: No.  40,  Mamma-Pituitary  Co.  (Harrower),  used 
for  the  control  of  uterine  bleeding,  whether  postpartum, 
climacteric,  fibroid,  or  even  in  cancer.  Made  originally  for  a 
prominent  Oakland  obstetrician,  this  formula  contains  a 
suitable  dose  of  Bon  jean's  ergotin,  which  clinical  experience 
has  shown  sensitizes  the  uterus  so  that  the  effect  of  the 
associated  remedies  is  most  direct.  This  is  a  rational  as 
well  as  an  effective  uterine  styptic,  exerting  its  influence 
from  within,  gradually  and  very  often  permanently.  Its 
value  is  broadened  by  the  utero-tonic  influence  of  the  added 
pituitary  gland  (total). 


216  PRACTICAL  ORGANOTHERAPY 

The  Influence  on  Fibroid  Tumors.  More  than  20  years 
ago  Robert  Bell,  of  London,  discovered  that  mammary  ex- 
tract exerted  an  influence  upon  the  uterine  fibromata  which 
caused  a  reduction  or  cure  of  the  menorrhagia  and  a  reces- 
sion in  their  size.  Feodoroff,  of  Petrograd,  wrote  many 
reports  on  the  subject  and  enthusiastically  advocates  this 
treatment.  As  a  matter  of  fact,  reports  enumerating  more 
than  a  hundred  cases  in  all  might  be  collected  from  the 
literature  extolling  mammary  extract  as  a  curative  remedy 
for  this  condition.  I  have  not  had  much  personal  success 
in  half  a  dozen  cases  personally  treated,  but  I  have  seen 
cases  that  responded  to  the  same  method,  while  a  number 
of  physicians  have  written  to  me  or  told  of  indubitably  good 
results.  I  prefer  not  to  urge  mammary  preparations  as  a 
means  of  remedying  fibroids  but  rather  to  recommend  their 
use  in  the  functional  conditions  such  as  show  themselves  in 
menorrhagia,  etc.,  but  I  will  not  deny  that  there  are  possi- 
bilities that  if  this  treatment,  preferably  perhaps  the 
Mamma-Pituitary  Co.  (Harrower),  is  used  to  control  the 
hemorrhagic  feature  of  the  fibroid  syndrome,  besides  the 
expected  benefit  to  the  menorrhagia  there  may  be  a  very 
pleasing  reduction  in  the  size  of  the  tumor.  Briggs,  of 
Sacramento,  is  a  more  recent  writer  on  this  subject  (Calif. 
State  Jour.  Med.,  Sept.,  1917.)  He  reports  his  experiences 
which  were  quite  encouraging  and  believes  that  the  mam- 
mary hormone  probably  antagonizes  the  uterine  stromal 
hormone,  thereby  modifying  or  preventing  excessive  hyper- 
emia  and  thus  controlling  menorrhagia  and  the  local  nutri- 
tion of  the  uterine  tissue  (fibroid).  The  effective  dosage 
depends  on  the  degree  of  hyperovarism.  I  learn  from  a 
physician  in  Mexico  that  the  above  formula  has  been  used 
by  him  for  six  months  in  a  woman  with  an  "inoperable 
fibroid,"  with  hemorrhages,  malnutrition,  and  a  heart  which 
precluded  surgery.  He  writes :  "The  excessive  flow  has  been 
entirely  controlled,  the  patient  is  better  in  every  way  and 
the  fibroid  is  reduced  fully  one  half." 

Interesting  Clinical  Experience.  A  physician  in  Oregon 
was  good  enough  to  write  me  about  his  experiences  with 
this  treatment,  and  a  part  of  his  letter  follows.  "The  first, 
an  unmarried  woman,  age  45,  has  a  large  tumor  of  the  right 
ovary.  She  is  entering  the  menopause  with  excessive  flood- 
ings.  Hemorrhages  lasting  (when  she  came  to  me)  for 
over  three  weeks ;  pallor  extreme ;  wild  expression  in  eyes ; 
face  tense  and  drawn.  Patient  perpetually  exhausted. 
After  local  examination,  bimanual,  no  instruments  at- 


MENORRHAGIA  217 

tempted,  put  her  in  bed  again  ten  days.  She  flooded 
for  eight  days.  She  had  a  lapse  of  only  two  weeks  (long- 
est period)  for  three  months  during  hemorrhages.  Put 
patient  on  Mamma-Pituitary  Co.  (Harrower) ,  as  indicated. 
Within  first  week  she  showed  marked  signs  of  improve- 
ment. The  next  period  came  in  four  weeks  and  she  flowed 
four  days  and  stopped — that  has  been  the  report  for  an- 
other two  months.  She  is  feeling  like  a  different  human 
and  her  friends  see  such  a  marked  improvement  they  won- 
der what  is  happening.  They  saw  great  changes  within 
the  first  week  of  administration  and  marvelled. 

"The  second  woman,  age  38,  married  fifteen  years,  ster- 
ile, has  a  uterine  fibroid.  Until  recently  she  had  considered 
herself  a  'well  woman'  but  complained  of  excessive  back- 
ache through  the  scapular  and  mid-dorsal  regions.  Ex- 
amination revealed  a  fibroid  the  size  of  a  large  infant's 
head  wedged  into  the  pelvis,  with  a  hard,  prominent  ball- 
shaped  mass  protruding  above  the  brim  of  the  pelvis ;  easily 
palpable  through  the  abdominal  wall.  She  flows  excessively, 
monthly,  7-8  days,  with  heavy  clots  and  is  very  weak  and 
pale  following  each  period.  First  month  after  administra- 
tion of  Mamma-Pituitary  Co.  she  flowed  four  days  and  the 
flow  was  and  is  in  strings  and  shredded  instead  of  in  large 
clots.  She  felt  stronger  and  able  to  do  housework  and  wash- 
ing, which  she  did.  Examination  shows  no  special  change 
intra-vagmally,  but  through  abdominal  wall  a  marked 
change.  The  'ball'  effect  has  softened  and  spread  out;  a 
most  pronounced  example  of  a  breaking-down  and  absorb- 
ing of  false  tissue.  Patient  is  passing  through  second  per- 
iod of  menstruation  since  dosage  began ;  the  change  is  most 
noticeable  to  her  own  palpation;  and  she  is  most  cons- 
cious of  a  general  improvement." 

The  Administration  of  Mammary  Products.  It  will  be 
recalled  that  a  step-ladder  method  is  recommended  for  the 
use  of  ovarian  preparations  (see  Chapter  5  of  this  Section), 
and  I  will  advise  a  modification  of  it  for  the  use  of  either  of 
the  formulas,  Nos.  38  and  40.  The  average  dose  is  five 
grains,  occasionally  ten,  three  times  a  day,  ordinarily  just 
before  meals.  This  is  increased  a  few  days  before  the  ex- 
pected flow  and  the  dose  continued  through  the  entire  flow, 
it  being  omitted  thereafter  for  perhaps  a  week  or  longer,  de- 
pending upon  circumstances,  and  repeated  for  several 
months,  always  pushing  the  dosage  just  prior  to  and  during 
the  menstrual  flow,  and  resting  for  a  while  immediately 
it  is  ended. 


218  PRACTICAL  ORGANOTHERAPY 

SECTION  V.    CHAPTER  10 
A  ROUTINE  TREATMENT  OF  HYPERTHYROIDISM 


Hyperthyroidism,  or,  as  it  is  sometimes  termed,  thyro- 
toxicosis,  is  one  of  the  principal  forms  of  thyroid  'dyscrasia, 
and,  as  stated  elsewhere  in  this  book,  is  at  once  the  best- 
known  and  the  most  complex  of  all  the  functional  thyroid 
diseases.  It  is  also  one  of  the  most  serious  problems  of 
medicine,  for  a  study  of  the  very  extensive  literature  on 
the  subject  rapidly  brings  us  to  the  conclusion  that  there 
is  much  diversity  of  opinion  in  regard  to  the  origin,  clinical 
relations,  and,  particularly,  the  treatment  of  this  disease.* 

The  Essential  Etiology.  It  is  still  claimed  by  many  that 
the  origin  of  hyperthyroidism  is  a  mystery.  To  my  mind, 
however,  toxemia — chemical,  bacterial,  endocrine  or  emo- 
tional— is  the  real  cause.  It  is,  however,  the  complicated 
associated  factors  which  constitute  the  principal  sources 
of  difficulty.  The  complexity  of  this  disease  and  the  fre- 
quent stubbornness  of  its  response  to  treatment — whether 
medical  or  surgical — makes  the  study  of  the  subject  so 
much  the  more  important.  The  fact  that  the  prognosis  is 
not  good,  and  that  radical  cures  are  by  no  means  the  rule, 
should  be  an  incentive  to  the  rank  and  file  of  the  profes- 
sion— who,  by  the  way,  encounter  by  far  the  majority  of 
cases  of  hyperthyroidism — to  study  this  subject  still  harder. 

In  this  syndrome  the  thyroid  gland  is  unusually  active, 
with  or  without  a  marked  increase  in  its  size.  "Exopthalmic 
goitre"  is  the  term  most  commonly  given  to  this  condition, 
though  an  excessive  thyroid  secretion  may  be  present  with- 
out the  exophthalmos,  and,  rarely,  the  exophthalmos  may 
be  in  evidence  without  the  goitre.  (Let  me  here  place  on 
record  that  I  am  not  in  favor  of  identifying  hyperthyroid- 
ism with  the  name  of  some  physician,  which  leads  to  some 
confusion.)  Parry  (who  originally  discovered  the  syndrome 
in  1786) ,  Flajani,  Graves,  and  von  Basedow  have  each  in 
turn  had  their  names  classed  with  the  syndrome,  the  last 
two  names  being  those  most  closely  linked  with  it. 


*  The  first  (January  1921)  issue  of  Harrower's  Monographs  on  the 
Internal  Secretions  is  on  this  subject  and  is  entitled  "Hype'rthyroid- 
ism:  Medical  Aspects."  It  contains  much  interesting  information 
collected  from  many  scattered  sources,  conveniently  arranged  and 
fully  bibliographe'd.  120  pages,  sewed,  price  $1.50  postpaid.  (The 
annual  subscription  for  this  quarterly  publication  is  $3.00.) 


A  ROUTINE  IN  HYFERTHYROIDISM  219 

Various  Lines  of  Treatment.  Hyperthyroidism,  unfor- 
tunately is  a  very  common  endocrine  manifestation,  espec- 
ially in  women  during  the  period  of  ovarian  activity.  The 
suggestions  in  regard  to  its  treatment  differ  widely.  Some 
advise  sedative  drugs,  others  alteratives;  still  others  urge 
destructive  measures  such  as  the  X-ray,  radium,  injections 
of  boiling  water,  or  a  solution  of  quinine  and  urea  hydro- 
chloride.  If  the  thyroid  is  enlarged,  and  there  are  a  number 
of  disconcerting  symptoms,  the  surgeon  removes  as  much 
of  it  as  he  dares.  The  medical  treatment  consists  largely 
in  rest,  sedative  drugs  like  the  bromides,  hydrobromide  of 
quinine,  chloretone — plus  an  expectant  attitude!  A  third 
method  of  treatment  consists  of  an  attempt  to  find  the  cause 
and  control  it  while  simultaneously  neutralizing,  as  may 
be  within  our  power,  the  erratic  glandular  dysfunction  and 
its  results.  This  last  procedure  will  be  given  further  con- 
sideration here  as  it  has  become  my  routine  in  all  cases  of 
hyperthyroidism. 

Medicine  Compared  With  Surgery.  While  I  am  not  op- 
posed to  surgery,  provided  medicine  has  failed  and  no 
removable  or  modifiable  underlying  causes  have  been  dis- 
covered, I  am  nevertheless  most  decidedly  against  the  re- 
moval of  an  enlarged  thyroid  gland  when  the  cause  of  such 
is  ignored  and  when  medical  measures  have  not  been  ap- 
plied. The  medical  treatment  as  mentioned  under  the 
second  heading  does  not  fit  in  with  my  idea  of  what  should 
be  done,  because  the  attempt  is  merely  to  control  symptoms ; 
it  may  be  advisable,  but  only  as  an  adjunct  to  a  better  pro- 
cedure. 

The  last  method  of  treatment  involves  three  important 
things  which  have  to  be  accomplished,  viz:  (1)  the  control 
of  toxemia,  and  especially  of  its  serious  cardiac  manifesta- 
tions; (2)  the  removal  of  sundry  and  widely  differing 
causes  of  thyroid  irritability;  and  (3)  the  reestablishment 
of  the  deranged  chemistry  and  the  restoration  of  the  badly 
disorganized  nutrition.  I,  in  common  with  a  growing  num- 
ber of  others,  favor  a  comprehensive  routine  which  will 
neutralize  not  merely  the  thyroid  dyshormonism,  but  simul- 
taneously will  care  for  all  forms  of  toxemia,  regulate  the 
diet  and  alimentary  conditions,  and  control  the  associated 
disturbances,  whether  causative  or  resultant.  Neverthe- 
less, each  of  the  two  schools,  whose  ideas  are  so  widely 
separated  fundamentally,  has  its  adherents  who  urge  their 
particular  viewpoint.  The  surgeon,  on  the  one  hand,  can- 
not see  eye-to-eye  with  his  medical  colleague,  while  many 


220  PRACTICAL  ORGANOTHERAPY 

a  statement  in  the  literature  emphasizes  the  superiority  of 
the  medical  as  compared  with  the  surgical  treatment  of 
hyperthyroidism,  taken  as  a  whole. 

From  my  own  standpoint  I  am  convinced  that  many  a 
failure  in  the  treatment  of  this  disease  is  as  often  due  to 
the  omission  of  essential  procedure  as  to  the  selection  of 
"a  wrong  method."  This  is  particularly  true  in  regard  to 
the  various  surgical  procedures.  The  greatest  satisfaction 
in  the  solving  of  this  difficult  endocrine  problem  comes 
from  the  studied  application  of  all  the  prospectively  useful 
measures,  some  of  which  have  been  indicated  above;  and 
fortunately  they  are  of  such  a  character  that  most  of  them 
may  be  used  together.  Rest,  diet,  hydrotherapy,  detoxica- 
tion,  the  X-ray,  organotherapy,  and  the  use  of  certain 
drugs,  may  all  be  fitted  together  and  made  part  of  a  routine 
treatment.  Then,  of  course,  associated  causative  elements, 
as  focal  infections,  emotional  factors,  and  disorders  of  other 
endocrine  glands,  necessarily  must  have  their  share  of  at- 
tention in  conjunction  with  the  active  treatment. 

Disturbances  in  Other  Glands.  Among  "other  endocrine 
disorders"  which  have  a  distinct  relation  to  hyperthyroid- 
ism may  be  mentioned  those  connected  with  the  pancreas, 
parathyroid  glands,  pituitary,  thymus,  gonads,  and,  most 
important  perhaps  of  all,  the  adrenals.  I  have  called  atten- 
tion repeatedly  to  the  frequency  of  hyperadrenia  in  hyper- 
thyroidism, and  believe  that  either  the  factors  which  irri- 
tate the  thyroid  into  excessive  activity,  or  the  actual  ex- 
cess of  the  normal  thyroid  principle,  suffices  to  stimulate 
the  adrenal  glands  abnormally,  with  a  resulting  irritability, 
sympatheticotonus,  and  later,  adrenal  depletion,  with  its  typ- 
ical asthenic  syndrome.  Experimentalists  such  as  Herring 
and  Hoskins  have  found  that  thyroid  feeding  causes  a  hy- 
pertropy  of  the  adrenal  glands  both  in  the  cortical  and 
medullary  portions.  Herring's  experiments  with  cats, 
which  were  fed  on  thyroid,  showed  adrenal  hyperplasia, 
with  an  increase  of  the  adrenin  content.  An  application  of 
this  in  practical  form  is  found  in  the  Goetsch  test,  already 
referred  to,  or  the  injection  of  adrenalin  in  supposedly  hy- 
perthyroid  cases.  A  further  hint  of  the  possible  relations 
between  the  adrenal  glands  and  the  thyroid  is  the  fact  that 
not  infrequently  in  hyperthyroidism  there  is  a  pigmenta- 
tion of  the  skin  just  as  there  is  in  Addison's  disease. 

Among  the  other  endocrine  glands  which  are  particu- 
larly likely  to  enter  into  the  etiology  of  hyperthyroidism  is 
the  thymus,  which  may  be  both  persistent  and  enlarged, 


A  ROUTINE  IN  HYPERTHYROIDISM  221 

thereby  adding  to  the  complex  what  has  been  called  hyper- 
thymism.  A  number  of  prominent  investigators  have  found 
that  a  goodly  percentage  of  patients  suffering  from  hyper- 
thyroidism  have  a  persistent  thymus  and  that  treatment 
calculated  to  reduce  the  thymus  (the  suitable  exposure  to 
the  X-ray,  perhaps  half  a  dozen  times)  not  merely  disposes 
of  the  thymus  but  mitigates  the  symptoms  of  the  hyper- 
thyroidism  very  materially.  Hence  a  condition  of  this  kind 
should  be  looked  for  in  every  case  and  disposed  of  when 
it  is  found. 

Finally,  the  ovaries  often  are  closely  related  to  dysthy- 
roidism,  and  when  one  appreciates  the  close  dependence  of 
the  thyroid  upon  the  gonads,  and  especially,  the  ovaries 
upon  the  thyroid,  it  is  clear  how  any  disturbed  function  of 
the  ovaries  may  react  upon  the  thyroid  sufficiently  to  de- 
range its  normal  routine.  Personally  I  do  not  believe  that 
hyperthyroidism  is  related  to  ovarian  dysfunction  as  often 
as  ovarian  dysfunction  is  related  to  hypothyroidism ;  but 
there  is  a  relation,  and  when  there  is  a  disturbance  of  ovar- 
ian function  it  should  be  sought  for  and  controlled,  and  this 
is  usually  best  accomplished  by  suitable  organotherapy. 

Failures  in  the  Treatment  of  Hyperthyroidism.  The 
greatest  source  of  failure  in  the  treatment  of  hyperthyroid- 
ism lies  in  ignoring  overlooked  causes ;  and  this  fault  is  the 
greater  when  the  treatment  planned  is  to  be  of  such  a  na- 
ture as  to  be  irrevocable.  I  cannot  lay  too  much  emphasis 
upon  the  fact  that  this  disorder  is  not  merely  an  irritability 
of  the  thyroid  gland,  with  a  corresponding  increase  in  the 
production  of  its  hormones.  As  a  matter  of  fact,  it  is  really 
a  manifestation  of  a  much  more  subtle  and  deeply-laid 
disturbance  in  the  functions  of  the  body.  As  I  see  it,  there 
are  three  fundamental  causes,  any  or  all  of  which  may  be 
related  to  the  onset  of  the  thyroid  irritability.  The  first  of 
these  may  consist  of  various  foci  of  infection,  and  every 
case  of  hyperthyroidism  should  be  very  carefully  examined 
from  every  possible  standpoint  so  as  to  exclude  conditions 
which  would  favor  the  absorption  of  bacterial  poisons  into 
the  system.  The  teeth,  tonsils,  sinuses,  lungs,  gall-bladder, 
intestines,  appendix,  and  pelvis,  all  should  be  carefully 
studied  from  this  standpoint,  and  if  it  is  believed  that  there 
is  a  condition  of  focal  bacterial  toxemia,  obviously  it  must 
be  taken  care  of,  for  no  treatment,  whether  surgery  of  the 
thyroid  or  the  very  best  medical  regimen — with  or  without 
such  measures  as  I  have  mentioned  here — could  possibly 
have  any  direct  influence  upon  a  focal  infection.  Inciden- 


222  PRACTICAL  ORGANOTHERAPY 

tally,  herein  lies  the  error  of  some  surgeons!  The  thyroid 
gland  is  so  obviously  at  the  root  of  the  serious  sympathetic 
imbalance  that  of  course  it  must  be  removed  forthwith, 
while  the  real  underlying  cause  remains  to  bring  as  much 
trouble  later  on, by  irritation  of  that  part  of  the  thyroid 
which  must  necessarily  be  left  behind.  This  is  wrong ;  but 
my  remark  does  not  mean  that  I  am  opposed  to  surgery 
under  certain  circumstances,  for  undoubtedly  it  is  occas- 
ionally necessary  and  decidedly  helpful;  but  I  have  seen 
too  many  post-operative  cases  to  believe  that  the  thyroid 
is  the  chief  offender.  It  is  merely  the  victim  of  circum- 
stances. 

The  emotional  aspects  of  hyperthyroidism,  too,  are  ex- 
tremely important.  Indeed  the  thyroid  function  may  be  un- 
balanced solely  as  the  result  of  a  mental  shock,  and,  without 
any  question,  instability  of  the  nervous  system  is  not  merely 
the  result  of  hyperthyroidism,  but  may  be  the  cause  of  it 
as  well.  This  complicates  matters  very  much  indeed  and 
explains  the  necessity  for  rest  and  a  congenial  environ- 
ment as  well  as  the  removal  of  all  factors  which  might  ag- 
gravate conditions  which  act  through  the  medium  of  the 
emotions.  It  also  explains  the  good  results  that  we  often 
secure  from  a  change  of  circumstances  and  cessation  of  all 
work  and  worry,  in  our  treatment  of  these  cases. 

As  we  have  seen  elsewhere  and  as  has  been  so  thoroughly 
emphasized  in  the  writings  of  Elliott  of  London,  Cannon  of 
Boston  and  Leopold  Levi  of  Paris,  the  emotions  exert  a  spe- 
cific effect  upon  the  chemistry  of  the  body  through  the 
faculty  of  the  adrenal  glands  to  respond  to  emotional  stimuli 
such  as  fright,  as  following  an  accident ;  fear ;  rage  or  anger ; 
pain,  and  even  worry.  All  these  excite  the  adrenals  and 
in  this  manner  sensitize  or  irritate  the  entire  sympathetic 
mechanism.  In  such  cases,  rest  and  the  removal  of  these 
emotional  tendencies  must  be  a  part  of  the  treatment. 

Antagonistic  Organotherapy.  The  immediate  treatment 
of  hyperthyroidism,  in  my  estimation,  centers  upon  the 
control  of  the  heart  action,  and  this  is  accomplished  quite 
satisfactorily  by  placing  the  patient  at  absolute  rest  in  bed 
in  a  quiet  room,  remote  from  worry  and  noise.  Suitable 
hydrotherapy  may  be  also  helpful.  An  important  remedy 
in  hyperthyroidism  is  the  infundibular  principle  of  the  pit- 
uitary gland,  and  injections  of  a  half  to  one  mil.  of  Liq. 
Hypophysis  (U.  S.  P.)  seem  to  exert  an  antagonistic  effect 
upon  some  of  the  underlying  dyscrinisms  and  also  to  slow 
the  support  of  the  heart. 


A  ROUTINE  IN  HYPERTHYROIDISM  223 

There  are  a  number  of  phases  of  organotherapy  that  may 
be  used  to  control  the  manifestations  of  hyperthyroidism, 
and  let  it  be  said  that  this  is  a  very  much  more  difficult 
proposition  than  the  treatment  of  hypothyroidism.  It  is 
obvious  that  all  of  these  patients  are  in  a  state  of  severe 
cellular  irritability,  and  the  sympathetic  nervous  -system  in 
particular  is  decidedly  "on  edge."  The  condition  is  techni- 
cally known  as  "sympathetico-tonus,"  and  is  the  opposite 
of  the  condition  known  as  "vagotonia." 

In  all  conditions  of  sympathetic  irritability,  the  adrenal 
glands  usually  are  hyperactive,  and  I  do  not  believe  that  a 
case  of  thyroid  excess  exists  that  is  not  complicated  by  an 
associated  hyperadrenia.  If  this  is  so,  the  use  of  the  nor- 
mal antagonist  to  the  adrenal  function — the  pancreas- 
should  contain  within  it  possibilities  of  distinct  value,  and, 
in  fact,  a  number  of  reports  in  the  literature  and  many 
personal  experiences  convince  me  that  pancreas  substance 
(not  pancreatin)  has  a  definite  sedative  value  in  this  dis- 
ease. 

A  number  of  authorities  have  recommended  pluriglandu- 
lar  combinations,  among  them  Andre  Crotti  of  Columbus, 
(who,  by  the  way,  also  emphasized  the  frequency  with 
which  there  is  an  ovarian  aspect  to  hyperthyroidism).  His 
formula  consists  of  equal  parts  (three  quarters  of  a  grain) 
of  desiccated  adrenal,  pituitary,  pancreas  and  ovary— 
total  gland  in  each  instance.  Several  French  writers  recom- 
mend adrenal  and  pituitary,  and  there  is  a  large  amount  of 
literature  from  which  it  may  be  gathered  that  dysovarism 
is  so  commonly  associated  with  hyperthyroidism  that  it  may 
be  the  sole  causative  element,  and  that  the  treatment  of 
ovarian  dysfunction  may  suffice  to  cause  a  marked  change 
for  the  better  in  the  thyroid  manifestations. 

I  have  been  using  and  recommending  a  pluriglandular 
formula  containing  the  same  ingredients  as  those  suggested 
by  Crotti  but  in  somewhat  different  proportions.  This 
formula  is  called  Pancreas  Co.  (Harrower),  and  each  5- 
grain  dose  consists  of  one  half  grain  each  of  total  adrenal 
and  pituitary  substance,  one  grain  of  ovary  and  three  grains 
of  desiccated  pancreas  gland.  The  first  two  may  have  some 
subtle  influence  upon  causative  elements  of  an  endocrine 
character  (several  writers  hint  at  this) ,  but  the  chief  reason 
for  their  inclusion  in  the  formula  is  because  of  their  sup- 
portive influence  upon  the  heart,  while  the  ovarian  sub- 
stance exerts  its  usual  effect,  and  the  generous  dose  of 
pancreas  is  a  physiological,  sympathetic  sedative.  This 


224  PRACTICAL  ORGANOTHERAPY 

formula  has  been  used  in  quite  a  number  of  cases,  and  its 
symptomatic  value  in  many  instances  seems  to  cause  just 
the  kind  of  steadying  needed  in  the  cellular  excitement  of 
Graves's  disease  and  allied  disorders. 

It  will  be  recalled  that  the  pancreas  and  adrenal  glands 
are  direct  antagonists,  and  one  may  wonder  why  these  an- 
tagonists are  given  together.  I  cannot  answer  this  as  easily 
as  the  question  may  be  asked.  It  is  possible  that  the  ad- 
renal gland,  which  includes  the  adrenal  cortex,  the  so- 
called  interrenal  organ,  has  some  influence  in  cases  of  this 
character,  for  certainly  this  gland  has  a  great  deal  to  do 
with  the  regulation  of  the  gonads  and  the  thyroid.  Looking 
at  it  from  another  standpoint,  it  is  possible  that  the  adrenal 
element  in  this  formula  is  useful  purely  for  its  effect  upon 
the  heart.  At  all  events,  the  combination  seems  to  be  su- 
perior to  the  use  of  either  adrenal  substance  or  pituitary 
alone,  or  the  use  of  pancreas  substance  alone. 

I  am  prompted  to  quote  several  paragraphs  from  a  letter 
received  personally  from  a  graduate  nurse  who  had  been 
developing  an  annoying  hyperthyroidism  which  resisted 
several  efforts  at  treatment,  and  who  was  referred  to  me 
by  a  relative  and  treated  at  somewhat  long  range. 

"My  markedly  improved  physical  condition  is  a  matter 
of  considerable  comment.  The  folks  at  the  hospital  got 
quite  excited  about  it  and  asked  many  questions  as  to  what 
you  had  been  giving  me,  how  long  I  had  been  under  treat- 
ment, dosage  effect,  etc.  Dr. was  especially  inter- 
ested as  he  had  previously  told  me  that  my  condition  was 
rather  serious  and  that  you  probably  had  nothing  suited 
to  my  particular  case.  I  told  him  how  various  symptoms 
had  been  fixed  up  and  he  thought  that  was  well  enough  but 
that  results  could  not  be  all  that  were  desired  unless  so 
proven  by  the  metabolism  test.  They  gave  me  the  test 
free  this  time  and  said  they  wanted  it  as  an  experiment.  I 
thought  you  might  also  be  interested,  as  the  B.  M.  R.  be- 
fore the  beginning  of  the  treatment  was  20  per  cent,  above 
normal  and  the  last  one,  5  per  cent  below."  And  in  this 
case,  while  the  metabolism  was  not  nearly  as  markedly  in- 
creased as  I  have  seen  it,  there  were  the  usual  nervous 
symptoms,  cardiac  irritability  and  rapid  pulse,  digestive 
disturbances  and  noticeable  loss  in  weight,  all  of  which  ap- 
parently were  regulated  by  the  organotherapy  that  is 
routinely  recommended. 

The  Associated  Treatment.  While  this  chapter  concerns 
essentially  the  endocrine  side  of  the  subject,  associated 


A  ROUTINE  IN  HYPERTHYROIDISM  225 

treatment  is  so  important  that  it  must  receive  attention 
also;  in  fact,  a  successful  outcome  in  hyperthyroidism  is 
the  result  of  the  appreciation  of  all  of  the  involved  factors 
and  their  simultaneous  treatment.  Obviously,  sources  of 
toxemia  must  be  removed,  and  the  colon  is  the  great  cause 
of  offense.  My  routine  treatment  in  such  cases  consists  in 
persistent  colonic  flushing,  oil  enemas,  and  intelligent  meas- 
ures calculated  to  unload  the  colon  and  loosen  accumulated 
concretions,  especially  at  the  angles  of  this  organ.  Too 
much  attention  cannot  be  paid  to  colon  hygiene  in  hyper- 
thyroidism. In  this  connection,  I  must  refer  to  the  frequent 
association  of  hyperthyroidism  with  mucous  colitis,  and  it 
may  be  well  to  give  consideration  to  the  suggestions  made 
in  the  chapter  on  that  subject.  After  the  colon  is  fairly 
well  cleaned  out,  regulate  the  diet  so  that  it  will  remain 
as  sweet  as  possible,  using  the  bacillus  bulgaricus  in  cul- 
tures, tablets,  or  cultured  milk.  If  necessary,  recommend 
suitable  intestinal  antiseptics,  avoiding,  however,  all  prepar- 
ations containing  iodin.  Finally,  since  the  hyperthyroid 
individual  is  burning  up  more  of  herself  and  her  food  than 
she  can  afford  to  lose,  a  generous  and  nutritious  diet  must 
be  given  and  special  efforts  taken  to  ensure  its  assimilation. 
Incidentally,  one  of  the  reasons  why  the  pancreas  gland  is 
a  useful  remedy  in  hyperthyroidism  is  due  to  the  fact  that 
it  also  encourages  the  pancreas  function,  which  concerns  di- 
gestion (external  secretion)  and  carbohydrate  metabolism 
(internal  secretion). 

Increasing  the  Alkaline  Reserve.  All  of  these  factors 
mentioned  must  be  considered  in  every  case  of  hyperthy- 
roidism and  suitable  indicated  treatment  be  carried  out.  Yet 
there  is  still  one  other  thing  that  needs  to  be  done  almost 
invariably.  Hyperthyroidism  is  very  commonly  associated 
with  demineralization.  The  underlying  causative  toxic  con- 
dition, besides  irritating  the  thyroid,  is  robbing  the  body 
of  its  alkali  mineral  reserve  in  the  manner  outlined  quite 
fully  in  the  chapter  on  Remineralization ;  hence,  to  all  of 
the  treatment  just  suggested  should  be  added  the  alkali 
mineral  salts,  such  as  the  body  requires,  in  generous  quan- 
tities to  neutralize  the  excessive  tendency  to  acidosis  or 
acidemia  so  common  in  these  cases. 

To  recapitulate:  The  treatment  .of  hyperthyroidism 
should  consist  (1)  in  a  search  for  causes  and  their  removal 
as  completely  as  may  be  possible;  (2)  the  support  of  the 
heart  and  antagonizing  of  the  sympathetic  irritability, 
preferably  by  the  use  of  the  pluriglandular  compound  Pan- 

15 


226  PRACTICAL  ORGANOTHERAPY 

creas  Co.  mentioned  above  (four  to  six  5-grain  doses  a  day, 
more  if  it  seems  advisable) ;  (3)  neutralization  of  the  ten- 
dency to  acidemia  and  the  building-up  of  the  mineral  re- 
serve may  be  accomplished  by  the  use  of  Calcium  Phos- 
phorus Co.,  of  which  three  grains,  crushed,  with  at  least 
a  full  glass  of  water  an  hour  before  food,  twice  a  day,  is 
a  suitable  dose  for  an  adult.  Finally  (4) ,  unload  the  colon, 
keep  the  alimentary  canal  as  clean  as  possible,  control  the 
emotions,  watch  out  for  the  diet,  and  urge  a  well  ordered 
and  quiet  existence — in  bed  for  several  weeks  or  longer 
if  necessary.  Until  all  these  procedures  have  been  ex- 
hausted, surgery  may  be  a  failure,  save  only  in  cases  of 
definite  thyroid  adenoma  with  thyrotoxicosis,  which  do 
not  constitute  a  large  percentage  of  the  cases  of  hyperthy- 
roidism. 

I  cannot  too  fully  emphasize  the  importance  of  doing 
everything  at  once — the  organotherapy  without  the  remin- 
eralization,  the  removal  of  toxemia,  etc.,  is  not  going  to  be 
especially  effective,  and  I  may  say  the  reverse  is  equally 
true  and  many  times  medical  and  hygienic  treatment  which 
has  not  been  causing  very  good  effects  has  been  made  more 
definitely  and  rapidly  successful  by  adding  the  organo- 
therapeutic  sedation  of  the  sympathetic  irritability  as  sug- 
gested here. 

Before  concluding  this  chapter  it  may  be  possibly  of  in- 
terest to  select  a  few  reports  of  cases  of  hyperthyroidism 
from  our  records  as  illustrative  of  the  fact  that  the  treat- 
ment recommended  by  us  is  indeed  able  to  "make  good"  in 
many  instances. 

A  young  married  woman  had  a  long  siege  of  difficulties 
with  hyperthyroidism  which  culminated  in  surgery.  About 
nine  months  later  she  came  with  her  trouble  "just  about 
as  bad  as  it  ever  was."  We  found  a  bad  appendix,  which 
was  removed.  We  neutralized  a  very  decided  acidosis 
(with  the  Calcium-Phosphorus  Co.  already  mentioned)  and 
gave  her  the  sympathetic  sedative  treatment  —  Pancreas 
Co.,  1,  q.  i.  d.  The  results  were  splendid.  The  pulse  prac- 
tically never  went  above  80,  and  the  patient  obviously  had 
improved  so  much  that  she  considered  herself  well.  But — 
she  had  a  near  accident  in  an  automobile;  nothing  really 
happened,  but  for  a  fraction  of  a  second  it  certainly  looked 
as  though  she  were  going  to  be  wrecked,  and  within  a  day 
or  two  all  her  troubles  were  back  again — to  my  mind,  typ- 
ical proof  of  the  emotional  aspects  of  this  difficulty.  The 
same  treatment  repeated  again  rendered  the  same  benefit. 


A  ROUTINE  IN  HYPERTHYROIDISM  227 

A  physician  in  St.  Louis  reported  to  me,  some  time  back, 
a  case  of  a  lady  with  hyperthyroidism  whose  husband  had 
been  told  by  a  prominent  surgeon  there  that  the  heart 
muscle  had  become  so  weakened  that  it  would  be  very  dan- 
gerous to  operate  on  her,  but  who,  following  the  adminis- 
tration of  this  routine  treatment,  "experienced  such  a 
change  in  the  heart  action,  and  general  betterment  that 
all  thought  of  operation  was  given  up." 

About  a  year  ago  a  California  doctor  wrote  me:  "I  am 
now  using  your  Pancreas  Co.  in  a  case  of  Graves's  dis- 
ease, and  although  the  treatment  has  only  lasted  10  days 
so  far,  there  is  marked  improvement.  Pulse  dropped  from 
120  to  87,  and  there  is  already  much  less  nervousness  and 
insomnia."  A  later  report  indicated  that  a  part  of  the  bene- 
fit, at  least,  has  proved  lasting. 

Here  is  an  unsolicited  report  indicating  the  possibilities 
in  certain  cases  of  hyperthyroidism : 

"You  may  recall  the  prescriptions  you  advised  me  to 
give  to  a  patient  who  had  exophthalmic  goitre.  For  months 
the  patient  had  been  under  care  of  a  very  good  physician 
and  surgeon  before  coming  to  me,  and  the  reason  for  chang- 
ing physicians  was  that  the  patient  was  told  'nothing  but 
an  operation  of  the  thyroid  would  help/  For  some  five 
months  I  had  this  patient  on  your  advised  prescription 
{Pancreas  Co.  (Narrower)  and  Calcium  Phosphorus  Co.  as 
outlined  in  the  reprint,  "My  Routine  in  Hyperthyroidism"] . 
Result:  Patient  gained  more  than  twenty  pounds  in 
weight,  sleeps  well,  thyroid  hypertrophy  now  unnoticeable, 
nervousness  disappeared,  eyes  receded  into  orbits  normally, 
and  patient  insists  that  'she  is  well.' ' 

I  hesitate  to  repeat  some  of  the  actual  reports-  for  I  am 
already  accused  of  stretching  the  truth.  But  I  can't  resist 
quoting  a  case  report  just  received  from  Nebraska,  as  I  edit 
this: 

"The  improvement  in  the  goitre  case  I  wrote  you  about 
is  so  wonderful  I  could  hardly  believe  my  eyes.  I  put  the 
patient  to  bed,  darkened  the  room  and  prohibited  any  form 
of  excitement.  No  application  was  used  to  the  thyroid. 
Pancreas  Co.  (Harroiver)  was  all  the  medicine  she  took. 
Exophthalmos  all  disappeared,  goitre  reduced  four  fifths  in 
size,  pulse  down  from  about  200  to  60.  No  one  could  be- 
come a  'therapeutic  nihilist'  if  he  could  see  this  woman's 
condition — what  she  ivas  and  what  she  is  now." 

The  foregoing  constitute  but  a  sprinkling  of  many  simi- 
lar typical  cases  where  "definite  results"  were  forthcom- 


228  PRACTICAL  ORGANOTHERAPY 

ing;  but  I  will  refrain  from  burdening  the  reader  by  un- 
necessarily prolonging  the  list.  Suffice  it  to  say  that  a  visit 
to  my  office  in  Glendale  would  more  than  repay  the  time 
and  effort  which  would  be  entailed,  for  we  have  literally 
scores  of  entirely  unsolicited  testimonials  from  physicians 
who  have  waxed  enthusiastic — and  rightly  so — over  the 
results  secured  in  their  patients,  not  only  in  the  particular 
disorder  under  review,  but  also  in  the  many  other  dyscrin- 
isms  dealt  with  in  this  necessarily  restricted  treatise. 


SECTION  V.    CHAPTER  11 
GLANDULAR  THERAPY  FOR  DEFECTIVE  CHILDREN 


The  problems  of  abnormal  growth  and  development,  es- 
pecially in  "children  requiring  special  attention,"  constitute 
a  very  serious  and  difficult  problem  in  medicine.  A  famous 
authority  once  said,  "Throughout  the  animal  kingdom, 
from  the  simplest  micro-organisms  to  the  most  complexly 
organized  beings,  that  inexhaustible  power  of  growth  has 
remained  as  one  of  the  most  remarkable  phenomena  of 
nature,  the  supreme  riddle  of  life."  Ever  so  often  we  find 
a  child  that  is  "different,"  "backward,"  "abnormal,"  whose 
disabilities  range  from  a  simple  tardiness  in  certain  of  the 
functions  of  the  body  to  a  developmental  dystrophy  which 
has  caused  a  material  reduction  in  th^  size  of  the  body,  in 
its  normal  development,  or  in  the  power  to  direct  it  nor- 
mally. Naturally  the  classification,  "defective  children,"  in- 
cludes a  very  wide  range  of  disturbances,  and  their  consid- 
eration in  a  short  chapter  necessarily  must  be  fragmentary. 

The  Endocrine  Control  of  Growth.  The  burden  of  my 
remarks  will  concern  the  relation  of  the  endocrine  glands 
to  these  developmental  disturbances,  and  I  am  convinced 
that  they  play  a  very  important  part,  both  in  the  normal 
outfolding  of  mental  and  physical  growth  and  the  physio- 
logical changes  associated  with  the  metamorphosis  from 
infant  to  adult,  as  well  as  in  the  pathological  modification 
of  these  changes.  In  other  words,  since  the  glands  of  in- 
ternal secretion  are  so  definitely  concerned  in  the  normal 
growth  of  the  individual,  we  must  expect  to  have  abnormal- 
ities in  these  glands  in  the  defective  ones,  and  if  the  basic 
principles  of  organotherapy  will  hold  good,  we  should  be 
able  to  modify  some  of  these  defects  by  applying  it. 


DEFECTIVE  CHILDREN  229 

In  the  class  of  cases  under  discussion,  many  of  the  "stig- 
mata" are  obviously  manifestations  of  an  organic  nature 
and  should  not  be  expected  to  be  remedied;  but  since  the 
underlying  element  is  a  disturbed  function  of  some  of  the 
endocrine  glands,  their  remarkable  responsiveness  to  hor- 
mone stimuli  may  enable  us  to  bring  about  some  noteworthy 
organic  changes,  so  that  even  in  these  cases  organotherapy 
may  assert  a  definite  influence  upon  structural  as  well  as 
functional  defects. 

In  children,  particularly  where  there  is  a  developmental 
defect  and  various  evidences  of  malnutrition  connected 
with  a  disturbed  function  of  the  endocrine  glands,  and 
where  dermatoses  are  imposed  upon  these  individuals,  the 
regulation  of  the  endocrine  aspect  sometimes  disposes  of  the 
dermatologic  trouble  simultaneously  and  oftentimes  mirac- 
ulously. A  study  of  the  endocrine  aspects  of  any  individual 
often  adds  much  to  our  knowledge  regarding  him,  and 
broadens  the  prospect  of  his  treatment. 

The  miraculous  changes  in  the  athyroid  cretin  made  pos- 
sible by  the  use  of  thyroid  extract,  have  been  one  of  the 
most  magnificent  advances  in  medicine,  and  it  is  well  known 
that  children  who  have  the  typical  manifestations  of  hy- 
pothyroidism  can  be  made  to  grow  and  develop  in  a  won- 
derful manner  by  supplying  the  missing  hormones.  It  hap- 
pens, however,  that  hypothyroidism,  pure  and  simple,  is 
rare,  since  the  absence  of  the  usual  thyroid  stimuli  cannot 
but  have  a  serious  influence  upon  other  endocrine  glands 
ordinarily  dependent  upon  these  stimuli ;  hence  the  cretin  is 
never  solely  a  thyroid  case.  The  same  applies  to  disturb- 
ances of  other  glands,  notably  of  the  pituitary.  It  has  been 
shown  that  the  pituitary  gland  exerts  a  remarkable  influ- 
ence upon  growth  and  sexual  development,  and  the  princi- 
pal manifestations  of  deficient  pituitary  function  are  a 
tendency  to  adiposity  and  sexual  mal-development — the 
adiposogenital  dystrophy  of  Froehlich.  The  diagnostic  side 
of  this  subject  is  more  thoroughly  considered  in  Section  IV, 
Chapter  6. 

Which  Cases  Respond  to  Organotherapy?  The  differ- 
entiation between  those  defective  children  that  are  likely 
to  respond  to  organotherapy  and  those  in  whom  there  is 
no  likelihood  of  benefit  is  very  difficult,  and  it  is  a  very  seri- 
ous thing  to  doom  a  child  to  lifelong  disability  by  saying 
that  this  method  of  prospective  merit,  or  that,  need  not  be 
employed  because  it  is  useless.  As  a  matter  of  fact,  case 
after  case  has  come  to  my  attention  whose  parents  have 


230  PRACTICAL  ORGANOTHERAPY 

said,  "My  Doctor  says  there  is  no  hope  for  Willie,  because 
he  has  given  him  thyroid  for  years,  and  while  he  benefited 
for  a  while,  he  isn't  any  better  in  the  last  year  or  so  and  I 
am  quite  discouraged."  In  cases  like  this,  the  usual  trouble 
is  a  "sin  of  omission."  The  interrelated  glands  have  been 
ignored,  and  dependence  has  been  placed  upon  thyroid  alone 
when,  in  fact,  the  thyroid  element  in  the  case  was  but  a 
part  of  the  syndrome.  Again,  errors  in  diagnosis  are  pos- 
sible, even  by  the  greatest  of  authorities  and  there  has 
been  quite  considerable  confusion  regarding  the  treatment 
of  these  cases,  largely  because  of  the  limited  viewpoint  of 
many  observers.  Now  that  a  large  amount  of  work  has 
been  done  with  the  pituitary  gland,  the  aggregate  of  results 
is  beginning  to  be  considerably  better. 

A  source  of  trouble  concerns  the  determination  of  cere- 
bral difficulties.  If  there  are  definite  changes  in  the  charac- 
ter of  the  cerebral  cortex,  or  if  there  are  developmental  de- 
fects in  the  cranium,  which  naturally  prevent  cerebral 
growth  and  function,  the  prospects  are  not  good,  and  many 
idiotic  children  are  quite  hopeless  for  this  particular  rea- 
son. The  hypocrinic  child,  on  the  other  hand,  is  merely 
sluggish,  not  idiotic  or  demented,  and  his  physiology  is 
merely  retarded,  and  it  has  been  shown  that  even  the 
growth  is  not  permanently  arrested,  which  is  proved  by  the 
fact  that  thyroid,  or  other  organotherapy,  completely 
changes  the  clinical  features.  There  is  always  a  possibility, 
however,  that  a  child  definitely  defective  from  a  cerebral 
standpoint  may  have  associated  with  this  trouble  a  suffi- 
ciently important  endocrine  phase  to  make  it  worth  while  to 
attempt  to  modify  it,  and  I  have  come  to  the  conclusion  that 
it  is  more  proper  to  attempt  organotherapy  in  those  cases 
in  which  the  prospects  are  poor,  than  to  deny  the  parents 
this  "last  straw." 

I  am  sometimes  asked  if  our  preparations  would  be  help- 
ful, say,  in  the  case  of  a  boy  of  15,  who,  while  not  deformed, 
may  have  only  attained  the  height  of  an  average  child  of 
ten.  In  cases  of  this  kind,  if  there  is  a  possibility  that  the 
boy  has  attained  his  maximum  growth  and  therefore  may 
not  respond  to  organotherapy,  it  is  possible  to  make  an 
X-ray  picture  of  the  hand  and  note  from  it  if  the  epiphyses 
are  joined  or  not.  If  they  are  joined  completely,  the  chances 
for  growth  are  not  so  good ;  if  they  are  not  joined,  there  are 
very  good  possibilities  of  increasing  the  height.  Some  of 
the  cases  elsewhere  reported  in  this  chapter  will  prove  in- 
teresting reading  in  this  connection. 


DEFECTIVE  CHILDREN  231 

Some  Results  From  Glandular  Feeding.  Since  pluri- 
glandular  disturbances  so  generally  are  the  rule  and  it  has 
been  shown  that  the  thyroid  and  pituitary  glands  are  re- 
lated in  the  causation  of  developmental  dystrophies,  it 
seems  highly  advisable  to  combine  preparations  of  these 
glands  rather  than  to  administer  them  singly.  I  have  shown 
in  my  "hypothesis  of  hormone  hunger"  (Section  II,  Chapter 
4)  that  a  mixture  of  extracts  when  given  to  the  body  is 
made  use  of  in  proportion  to  the  demands,  and  that  it  is 
presumable  that  moderately  superfluous  quantities  of  these 
substances  remain  in  the  circulation  until  the  time  comes 
for  their  use,  or  they  are  oxidized.  At  all  events,  the  pluri- 
glandular  feeding  of  defective  children  has  been  a  good 
deal  more  successful  in  my  hands,  as  well  as  in  those  of  a 
good  many  of  my  friends,  than  thyroid  or  pituitary  or  thy- 
mus  alone,  all  of  which  have  been  recommended  in. the  liter- 
ature as  of  use  in  these  cases.  I  have  therefore  combined 
these  preparations  in  suitable  amounts  in  a  combination 
now  known  as  Antero-Pituitary  Co.  (Harrower) ,  each  dose 
of  which  contains  2  grains  of  the  desiccated  anterior  lobe  of 
the  pituitary  body,  1  grain  of  thymus,  1-12  grain  of  thyroid, 
with  the  mineral  salts  which  correspond  to  those  found  in 
the  blood.  This  formula  has  been  used  in  many  defective 
children,  and  if  there  is  no  cerebral  difficulty,  as  in  idiocy, 
the  backwardness  of  mentality  and  the  development  may  be 
modified  by  it,  for  defective  children  always  have  a  well- 
defined  endocrine  feature.  I  have  seen  a  number  of  cases 
in  whom  it  was  eminently  successful — of  a  child  of  two  or 
three  years,  previously  unable  even  to  sit  up,  who  has  not 
only  learned  to  sit  and  crawl,  but  to  walk;  of  children  of 
five  to  seven  who  had  never  been  able  to  speak,  who  in  six 
or  eight  months  were  able  to  make  intelligible  sentences 
of  five  or  six  words;  of  children  of  eight  years  who  had 
been  persistently  constipated  from  birth  and  who  "had 
never  had  a  normal  bowel  movement  in  their  lives,"  whose 
alimentary  conditions  were  modified  and  the  constipation 
entirely  controlled  without  cathartics.  (Parenthetically, 
it  may  be  well  to  state  that  one  of  the  common  manifesta- 
tions of  endocrine  deficiency  is  cellular  infiltration,  muscu- 
lar atonicity  and  asthenia,  all  of  which  very  definitely  favor 
chronic  alimentary  insufficiency  and  stasis.) 

An  Interesting  Case.  I  cannot  refrain  from  alluding  here 
to  a  case  which  I  believe  has  already  been  quoted  in  some 
of  my  literature:  that  of  a  four-year-old  defective  child 
who  was  brought  to  me  by  a  lady  for  study  and  suggestions. 


232  PRACTICAL  ORGANOTHERAPY 

In  doing  this  she  was  acting  on  the  recommendation  of  a 
physician  who  had  been  converted  to  the  reasonableness 
of  my  ideas.  The  boy  could  neither  speak,  walk,  nor  even 
sit  up ;  he  had  no  control  over  the  bowels  or  urination,  had 
very  poor  powers  of  perception  and  was  regarded  as  an 
idiot,  with  no  chance  whatever.  He  was  treated  for  several 
months,  on  and  off,  with  Antero-Pituitary  Co.  (Harrow er) , 
the  parents  being  told  that  this  was  a  gamble  and  was  sug- 
gested on  the  off-chance  that  the  boy  might  have  a  suffi- 
ciently definite  endocrine  phase  to  the  difficulty  to  make 
it  possible  there  might  be  some  worth-while  benefit.  Em- 
phasis was  laid  on  the  large  chance  of  failure.  The  parents, 
being  desperate  and  without  hope,  elected  to  "try  me  out." 
When  I  next  saw  the  boy  he  was  able  to  walk,  run,  sit  up, 
and  climb  like  a  normal  boy,  and  his  mentality  had  de- 
veloped amazingly.  While  he  could  not  speak  plainly,  and 
probably  will  never  be  able  to  do  so,  the  bother  of  having 
to  transport  him  from  place  to  place  was  a  thing  of  the 
past.  He  has  better  intelligence  and  is  a  source  of  greater 
joy  to  his  parents,  and,  though  much  is  still  to  be  desired, 
they  felt  very  grateful  for  what  had  been  done.  This  story 
had  a  strange  aftermath.  The  mother's  aunt  was  a  phy- 
sician's wife.  The  worthy  physician  passed  judgment  on 
the  case,  and  it  was  unfavorable!  He  also  passed  judgment 
on  me  and  the  phase  of  medicine  that  we  are  trying  hard 
to  develop.  This,  too,  was  unfavorable!  In  fact,  he  urged 
them  against  consulting  me  and,  a  few  months  later,  ad- 
vised them  to  abandon  my  treatment.  And  now  the  doc- 
tor, according  to  the  mother,  says:  "Well,  it  might  have 
happened  anyway" !  Such  is  life. 

I  may  perhaps  be  pardoned  for  quoting  another  case 
brought  to  our  notice  by  a  Maryland  physician:  A  de- 
fective girl  of  nine,  who  had  never  spoken,  and  who  had 
to  be  supported  under  the  arms  in  order  to  take  a  few 
steps,  which  she  could  not  do  volitionally.  When  our  medi- 
cal correspondent  first  took  her  in  charge,  the  tongue 
seemed  to  fill  the  whole  mouth  and  rested  on  the  tip ;  there 
was  constant  drooling  and  she  could  swallow  with  difficulty. 
It  was  quite  impossible  to  see  the  tonsils.  Her  elbows  and 
wrists  were  semiTflexed,  and  while  she  could  stand  by  being 
propped  up  in  a  corner,  she  always  rested  on  the  tips  of 
her  toes.  Apparently  impressions  were  received  through 
the  ears.  Constipation  was  marked  and  the  urine  scanty. 
Her  parents  had  had  the  best  specialists  in  Baltimore,  and 
the  prognosis  was  that  she  "might  walk  but  would  never 


DEFECTIVE  CHILDREN  233 

talk."  The  doctor  went  on  to  state  that  two  months  after 
prescribing  Antero-Pituitary  Co.  (Narrower),  the  child's 
tongue  had  come  down  to  normal  size,  and  the  soft  palate 
had  been  taken  up  to  its  proper  height.  The  whole  expres- 
sion of  her  face  was  improved.  The  head,  unfortunately, 
was  about  two  inches  too  small,  but  he  was  hoping  there 
might  be  an  energizing  of  the  whole  skull.  Certainly,  he 
added,  the  seeming  exostosis  above  the  eyes  had  vastly  im- 
proved in  appearance,  and,  "while  there  is  life,  there  is 
hope."  She  had  better  accommodation  of  vision  and  could 
already  see  about  12  inches  from  the  eyes.  The  guttural 
sounds  emitted  had  taken  on  a  higher  pitch,  and  she  could 
stand  on  both  feet  with  fairly  good  arches— assuredly  a 
great  improvement.  In  commenting  on  this  in  one  of  my 
other  publications  I  opined  that  this  child  had  a  large  thyro- 
pituitary  aspect  to  the  underlying  disorder.  Certainly  no 
other  measure,  save  organotherapy,  could  have  brought 
about  marvelous  changes  like  those  mentioned.  With  the 
good  doctor,  "I  have  no  promises"  to  give  these  people, 
but  surely  the  prospects  for  still  further  improvement  are 
far  brighter  today  than,  say,  three  months  ago. 

Remarkable  Growth  Stimulation.  I  have  seen  children 
who  have  attained  the  age  of  fifteen  or  sixteen,  with  no 
growth  whatever  for  five  or  more  years,  suddenly  begin  to 
grow  and  change  following  the  application  of  this  formula ; 
in  one  case  as  much  as  one  inch  in  9  weeks — another,  that 
of  a  defective  girl  of  five  who  could  not  speak  and  who  after 
using  the  formula,  in  6  months  was  making  five  and  six- 
word  sentences,  with  other  improvement.  I  recall  one  boy  in 
particular  who  was  fifteen  and  a  half  when  I  first  saw  him ; 
height  four  feet  four  inches;  general  contour  stubby  and 
ugly,  with  a  temperament  that  was  very  unfortunate — he 
was  almost  impossible  to  get  along  with.  His  liver  was 
stimulated  a  little  (with  my  Bile  Salts  Co.,  referred  to 
elsewhere)  and  the  Antero-Pituitary  Co.  (Harroiver), 
was  given,  with  the  result  that  within  four  months  he 
had  gained  two  inches  and,  better  still,  his  temperamental 
difficulties  disappeared.  A  letter  from  Washington,  dated 
Jan.  13,  1920,  contained  the  following  item  of  information : 
"Our  backward  boy  has  gained  three  inches  in  height  and 
is  doing  much  better  in  school.  He  began  taking  the  An- 
tero-Pituitary Co.  last  June." 

Another  striking  case  was  that  of  a  girl  of  nearly  15, 
development  and  height  those  of  a  girl  of  ten,  who  grew 
four  inches  after  taking  this  formula  for  less  than  three 


234  PRACTICAL  ORGANOTHERAPY 

months.  I  have  seen  infantilism  in  children  at  puberty 
modified  by  this  formula  or  another  similar  to  it  containing 
extracts  of  the  gonads.  In  fact,  in  these  grown-up  children 
that  do  not  mature,  not  merely  is  a  satisfactory  develop- 
ment possible,  but  in  some  of  the  older  ones  fecundity  ac- 
tually has  been  established.  Finally,  a  number  of  these 
peculiar  children  in  whom  the  general  symptom-complex 
included  epilepsy,  both  of  the  petit  mat  and  grand  mal  types, 
not  merely  have  changed  from  a  morphogenic  standpoint, 
but  the  epileptic  seizures  have  been  entirely  controlled. 
This  subject  is  taken  up  more  fully  in  the  chapter  entitled 
"Epilepsy  from  an  Endocrine  Standpoint,"  which  follows. 

Persistence  is  Necessary.  To  determine  in  advance  how 
well  this  treatment  may  work  is  impossible,  for  medical 
men  are  not  prophets  and  have  no  way  of  knowing  exactly 
what  endocrine  disturbance  is  present  nor  how  well  these 
glands  may  respond  to  suitable  stimulation.  Hence,  it  is 
necessary  to  explain  to  the  parents  that  while  results  have 
been  favorable,  one  cannot  predict  accurately.  It  is  the  rule 
for  these  parents  to  ask  how  long  it  will  take,  and  one  can- 
not answer  definitely.  They  practically  always  ask  to  what 
degree  this  symptom,  or  that,  may  be  controlled,  and  it  is 
equally  impossible  to  say.  It  is  my  custom  to  tell  them 
that  since  this  measure  has  been  effective  before  and  as 
they  have  never  tried  it  yet  (for  most  of  them  come  after 
having  used  a  single  gland  extract  or  followed  organother- 
apy for  a  few  weeks  or  months) ,  it  is  worth  trying  and  we 
will  hope  that  the  results  will  be  good.  They  should  be 
told  by  the  physician  that  this  is  "the  most  hopeful  side 
of  attack" ;  that  endocrine  insufficiency-  has  been  connected 
with  conditions  similar  to  the  one  in  mind ;  that  the  formula 
to  which  attention  is  here  drawn  has  made  many  physicians 
pleased  and  brought  joy  to  many  a  mother,  and  that  it  is 
to  be  hoped  that  in  this  particular  case  the  outcome  will  be 
good  also. 

At  all  events,  in  all  these  cases  the  real  attempt  is  to 
reestablish  the  deficient  functions  —  to  educate  certain 
glands ;  and  this  form  of  education,  as  with  all  other  forms, 
takes  time.  Gland  feeding  must  be  continued  for  a  mini- 
mum of  six  months.  It  is  useless  to  commence  unless  you 
can  secure  a  promise  to  stick  to  it  for  this  length  of  time. 
It  must  be  given  regularly  and  the  results  must  be  watched 
carefully  and,  if  necessary,  the  treatment  modified  to  suit 
the  changing  conditions.  Naturally,  every  associated  effort 
to  favor  the  desired  outcome  should  be  advised,  and  particu- 


ENDOCRINE  EPILEPSY  235 

lar  attention  should  be  paid  to  elimination  and  to  the  met- 
abolism of  the  mineral  salts,  a  subject  which  has  been  con- 
sidered in  another  chapter — "The  Mineral  Salts  in  Health 
and  Disease :  Remineralization."  (Section  V,  Chapter  25.) 
To  accomplish  this  the  use  of  Calcium  Phosphorus  Co. 
(Harrower),  is  recommended. 

The  dosage  is  usually  three  5-grain  doses,  at  meals;  the 
former  in  children  under  six  months  will  suffice  for  a  time. 
I  am  in  the  habit  of  prescribing  this  formula  to  be  taken 
for  four  out  of  every  five  weeks.  During  this  period  of 
treatment,  if  the  symptoms  of  thyroid  insufficiency  pre- 
dominate, I  would  add  from  one  fourth  to  one  half  grain 
of  thyroid  t.  i.  d. 

In  conclusion,  I  want  to  emphasize  my  position  about 
recommending  this  treatment.  It  is  a  chance ;  it  fails  prob- 
ably more  often  than  it  succeeds  and  the  "successes"  might 
not  always  be  quite  satisfactory  to  a  critic.  I  know  that  its 
application  has  caused  joy  many  times;  and  such  joys  far 
outweigh  the  failures — and  cannot  be  attained  unless  we  try. 


SECTION  V.    CHAPTER  12 
EPILEPSY  FROM  AN  ENDOCRINE  STANDPOINT 


It  seems  to  be  the  custom,  since  the  endocrine  glands 
and  preparations  have  done  so  many  wonderful  things,  to 
expect  to  find  help  from  them  in  all  puzzles  that  we  have 
failed  to  solve  for  years.  This  may  be  all  very  well,  and 
occasionally  we  stumble  over  some  remarkable  things  which 
keep  up  our  courage,  but  when  it  comes  to  expecting  a  con- 
sideration of  the  ductless  glands  and  organotherapy  to  give 
us  the  open  sesame  to  the  mysteries  of  insanity,  paralysis 
agitans,  dwarfism,  sterility  and  epilepsy — all  of  them  "hard 
nuts  to  crack" — it  almost  seems  that  we  are  asking  too 
much.  Yet  the  fact  is  that  there  are  greater  prospects  to- 
day in  the  treatment  of  every  one  of  these  mentioned  con- 
ditions from  the  endocrine  standpoint  than  from  any  other 
procedure  considered  up  till  the  present  time. 

Epilepsy:  "The  Mysterious  Disease."  Epilepsy  is  one 
of  the  big  puzzles  of  medicine.  We  have  a  lot  to  learn  about 
it,  even  though  our  more  recent  knowledge  about  the  diet- 
etic and  toxic  (alimentary)  causes  is  growing,  and  the  re- 
lation between  the  glands  of  internal  secretion  and  the  epi- 


236  PRACTICAL  ORGANOTHERAPY 

leptic  syndrome  seems  to  be  receiving  much  more  attention. 
The  universal  dependence  upon  the  bromides  or  other  neuro- 
sedative  drugs  is  a  poor  makeshift,  and  altogether  on  a  par 
with  the  morphin  injection  for  an  access  of  pain.  Such  an 
injection  does  not  cure  the  disease,  any  more  than  bromides 
cure  epilepsy.  But  when  someone  comes  along  and  says 
that  certain  gland  feeding  has  been  accompanied  in  one  case 
of  undoubted  epilepsy  by  a  reduction  of  the  number  of  at- 
tacks, 50  per  cent.,  75  per  cent.,  or  even  more,  we  have  a 
perfect  right  to  "sit  up  and  take  notice." 

It  will  be  my  effort  to  emphasize  the  importance  of  the 
disorders  of  the  ductless  glands  as  they  may  pertain  to 
epilepsy  and  to  suggest — not  to  announce — a  treatment 
which  may  give  us  a  greater  degree  of  satisfaction  in  epi- 
lepsy than  the  unscientific  and  truly  disgraceful  method  of 
stuffing  the  sufferers  with  bromides  morning,  noon  and 
night. 

Is  there  any  relation  between  disturbances  in  the  glands 
of  internal  secretion  and  epilepsy?  If  so,  there  may  be 
some  hope,  and  a  statement  of  some  of  the  findings  in  the 
literature  may  give  us  reason  for  applying  this  principle 
in  our  treatment  of  epilepsy. 

A  Thyroid  Factor  in  Epilepsy.  It  has  been  shown  in 
many  communications  that  disorders  of  the  thyroid  gland 
may  be  accompanied  by  epilepsy.  In  a  paper  entitled  "The 
Relation  of  the  Thyroid  Gland  to  Epilepsy"  (Lancet-Clinic, 
July  29,  1916),  I  collated  a  good  deal  of  information  which 
seemed  to  establish  the  belief  that  hypothyroidism  was  a 
factor  in  the  cause  of  epilepsy  and  that  when  an  epileptic 
was  found  with  an  associated  hypothyroidism,  the  treat- 
ment with  obvious  organotherapy — thyroid  extract — might 
have  some  beneficial  influence  upon  the  epilepsy  also. 
Gauthier,  in  his  book,  published  in  1913,  has  gathered 
many  communications  in  French  medical  literature,  and  a 
brief  quotation  from  this  should  suffice:  "Epilepsy  is  con- 
sidered by  a  large  number  of  physicians  and  neurologists  to 
be  an  intoxication,  or  a  general  disorder  of  the  metabolism. 
There  is  also  a  possible  connection  in  certain  cases  with 
the  work  of  the  thyro-parathyroid  combination.  The  asso- 
ciation of  epilepsy  with  myxedematous  idiocy,  cretinism 
and  even  Basedow's  disease  is  well  known.  But  there  are 
other  evidences.  Many  cases  of  simple  goitre  become  epi- 
leptic and  goitrous  mothers  give  birth  to  epileptic  children. 
Claude  and  Schmiergeld,  in  a  study  of  seventeen  cases  of 
epilepsy  from  the  endocrine  point  of  view,  have  found  in 


ENDOCRINE  EPILEPSY  237 

every  case  alterations  in  the  thyroid  gland  and  in  twelve 
of  these  the  structure  of  the  gland  was  completely  altered 
with  the  areas  of  sclerosis  and  limited  zones  of  compen- 
satory hypertrophy  of  the  glandular  tissue.  .  .  .  Parhon 
examined  the  thyroid  in  twelve  epileptics,  and  found  it 
smaller  than  usual  and  showing  frequent  and  variable  his- 
tologic  changes."  Many  other  convincing  experiences  and 
references  will  be  found  in  the  third  issue  of  Harrower's 
Monographs  on  the  Internal  Secretions,  which  is  entitled 
"Epilepsy  as  an  Endocrine  Syndrome."  (This  80-page  pub- 
lication will  be  sent  on  approval  to  any  interested  physi- 
cian.) 

From  the  information  gathered  together  here  and  else- 
where, we  are  justified  in  drawing  some  conclusions: 

1.  That  the  thyroid  insufficiency  is  likely  to  be  a  fre- 
quent underlying  factor  in  the  etiology  of  epilepsy  for 
several  reasons:    (a)  It  favors  toxemia;    (b)  it  produces 
cellular  infiltration  and  edema,  which  may  affect  the  brain 
in  the  manner  described  by  Hertoghe,  Reed  and  others,  and 
(c)   it  usually  causes  other  sypmtoms  in  epilepsy  which 
have  been  definitely  attributed  to  hypothyroidism. 

2.  Thyroid  therapy  is  a  rational  therapeutic  adjunct  in 
the  treatment  of  epilepsy  accompanied  by  other  signs  of 
h  ypothy  roidism, 

3.  Favorable  results  from  the  use  of  thyroid  extract  in 
epilepsy  should  be  considered  as  a  confirmation  of  these 
conclusions. 

Involvement  of  the  Pituitary  Gland.  Still  another  gland  of 
internal  secretion  has  something  quite  definite  to  do  with 
epilepsy.  This  is  the  pituitary  gland,  a  mysterious  organ 
which  regulates  many  functions  of  the  body  and  about  which 
practically  all  our  knowledge  has  been  developed  in  the  last 
fifteen  or  twenty  years.  Just  why  the  pituitary  should 
cause  epilepsy  does  not  seem  to  be  very  clear  save  only  as 
increased  intra-cranial  pressure  from  an  enlarged  gland 
might  cause  pressure  upon  local  structures  which,  in  turn, 
might  cause  the  typical  experiences  which  we  call  epilepsy. 
Some  writers  have  thought  that  the  circulatory  disorders 
quite  common  in  epilepsy — slow  pulse,  vasomotor  stasis, 
low  blood  pressure,  with  a  tendency  towards  obesity  and 
an  abnormal  appetite — are  somewhat  similar  to  conditions 
which  obtain  when  there  is  well  defined  pituitary  disease. 
Harvey  Gushing,  the  world's  best  authority  on  the  pituitary 
gland,  gives  six  reasons  why  pituitary  insufficiency  is  related 
to  epilepsy.  In  brief,  they  are  as  follows:  (1)  Horsley,  of 


238  PRACTICAL  ORGANOTHERAPY 

London,  noted  increased  excitability  of  the  motor  cortex  in 
liypophysectomized  dogs.  (2)  Epileptiform  convulsions  were 
frequently  seen  in  animals  which  survived  for  long  periods 
after  partial  removal  of  the  pituitary  (Gushing).  (3)  "Ep- 
lepsy  is  a  frequent  accompaniment  of  clinical  conditions  in 
which  an  insufficiency  of  the  pituitary  is  manifest."  (4) 
The  pituitary  may  be  damaged  from  a  bursting  fracture  of 
the  base  of  the  skull.  (5)  It  is  believed  the  posterior  lobe 
secretion  enters  the  spinal  fluid,  thereby  bathing  the  cortex 
with  a  substance  essential  to  the  functional  stability  of  the 
cortical  cells.  (6)  "Many  individuals,  supposed  to  be  suf- 
fering from  so-called  genuine  epilepsy,  present  symptoms 
of  pituitary  insufficiency  and  in  some  of  these,  pituitary  ex- 
tract has  served  to  moderate  the  seizures."  Based  upon 
these  conclusions,  a  good  deal  of  experimental  gland  feed- 
ing has  been  done  in  epileptics,  and  certainly  far  better  re- 
sults have  been  obtained  than  before  this  matter  was  given 
consideration. 

Adrenal  Irritability.  Still  further  study  of  epilepsy  has 
involved  other  glands,  and  Cotton,  at  the  New  Jersey  State 
Hospital,  has  come  to  the  conclusion  that  there  may  be  an 
unusual  irritability  of  the  sympathetic  system  due  to  the 
action  upon  the  adrenal  glands  of  poisonous  products  from 
the  intestines.  Further,  according  to  Cotton,  adrenal  activ- 
ity also  may  be  caused  by  (1)  pituitary  dysfunction,  (2) 
pancreas  dysfunction,  (3)  irritation  of  the  duodenum,  and 
^4)  severe  fright  or  emotional  disturbances.  His  idea  was 
to  antagonize  the  adrenal  irritation  by  the  use  of  the  normal 
antagonist  to  these  glands — the  pancreas — and  preparations 
of  this  character  have  had  "a  decided  effect  in  stopping  the 
convulsions." 

Possibly  other  glands  have  been  connected  with  epilepsy, 
but  in  order  not  to  complicate  an  already  complex  matter 
we  will  continue  our  study  of  the  propositions  discussed. 

Evidently  there  are  several  underlying  or  exciting  causes 
of  epilepsy  that  are  connected  with  the  glands  of  internal 
secretion,  and  whenever  it  is  possible  to  discover  some  en- 
docrine disturbance  in  an  epileptic,  the  rational  thing  to  do 
is  to  attempt  to  modify  it  as  quickly  as  possible.  Unfor- 
tunately, however,  we  cannot  always  assure  ourselves  of  the 
presence  of  these  disturbances  and  the  patients  have  well- 
defined  epilepsy  and  want  help,  and  I  am  sorry  to  say  that 
most  of  use  heretofore  have  been  giving  nerve  paralyzants 
or  sedatives  as  recommended  in  the  text  books.  "What  else 
is  there  that  we  can  do,  anyway?" 


ENDOCRINE  EPILEPSY  239 

I  believe  that  it  is  no  more  unscientific  to  presume  that  a 
given  endocrine  disturbance  may  be  the  underlying  cause 
of  epilepsy  and  to  treat  it  experimentally,  than  it  is  to  fill 
the  patient  up  with  a  drug  that  we  know  perfectly  well  does 
not  go  to  the  bottom  of  matters  and,  worse  still,  is  insid- 
iously destroying  functions  (especially  mental)  which  may 
not  be  restored,  once  definitely  damaged. 

The  Endocrine  Element  in  Epilepsy.  I  do  not  think  that 
it  is  wrong  to  "jump  a  ditch"  once  in  a  while  or,  in  other 
words,  to  attempt  to  accomplish  some  end  in  a  manner  that 
we  cannot  accurately  explain  or  predict  the  outcome  of. 
This  means  that  /  believe  that  endocrine  disturbances  are 
sufficiently  commonly  associated  with  epilepsy  to  warrant 
our  using  means  ordinarily  applied  in  the  treatment  of  these 
endocrine  disturbances  as  a  part  of  the  treatment  of  such 
cases.  If  the  motor  excitability  is  tremendous,  we  must  use 
sedatives  just  as  we  use  an  anesthetic  in  eclampsia,  but 
always  as  a  part  of  a  treatment  which  has  a  greater  pros- 
pect of  the  results  than  the  sedative  itself  alone. 

How  are  we  to  know  what  glands  to  give  in  epilepsy? 
Several  phases  of  the  subject  are  mentioned  and  they  seem 
to  differ  quite  considerably.  It  is  not  difficult  to  establish 
the  fact  that  a  given  individual  is  suffering  from  thyroid 
insufficiency.  If  it  may  not  have  reached  the  stage  of  the 
usual  symptomatology,  there  can  be  no  objection  to  using 
Harrower's  "Thyroid  Function  Test"  (Sec.  IV,  Chap.  4)  and 
seeing  how  the  individual  reacts  to  this.  We  have  no  way 
of  connecting  the  pituitary  gland  with  a  given  case  of  epi- 
lepsy save  by  the  usual  study  and  examination  (Sec.  IV, 
Chap.  6)  and,  perhaps,  the  administration  of  the  gland  on  a 
chance.  The  condition  of  adrenal  irritation  discussed  above 
properly  may  be  treated  by  the  removal  of  all  causes  of  this 
condition,  especially  toxemia,  by  antagonizing  the  adrenals, 
if  it  seems  advisable,  in  harmony  with  Cotton's  suggestion, 
and  particularly  by  increasing  oxidation  by  enhancing  thy- 
roid and  pituitary  function  so  that  the  accumulation  of 
poison  will  not  drive  the  adrenals  so  hard. 

Treatment  of  Ovarian  Epilepsy.  For  20  years  it  has  been 
suggested  that  certain  forms  of  epilepsy  are  definitely  con- 
nected with  dysovarism.  Clinical  experiences  have  shown 
also  that  the  thyroid  as  well  as  the  pituitary  may  be  in- 
volved in  this  difficult  condition.  If  there  is  a  decided  endo- 
crine aspect  to  any  patient  with  epilepsy  it  is  surely  correct 
and  proper  to  attempt  to  modify  the  endocrine  condition, 
and  then  if  the  epilepsy  is  simultaneously  benefited  every- 


240  PRACTICAL  ORGANOTHERAPY 

body  is  satisfied.  Therefore,  in  cases  where  there  is  an 
ovarian  element,  instead  of  treating  the  epilepsy,  try  to 
regulate  the  ovarian  condition.  I  have  several  interesting 
cases  on  my  records,  one  of  which  may  be  mentioned  here: 
A  physician  had  a  case  of  epilepsy  which  was  not  respond- 
ing to  treatment.  After  a  long  time,  it  seemed  that  there 
might  be  some  relation  between  the  convulsions  and  the  ova- 
rian function  and  my  Thyro-Ovarian  Co.  was  given.  The 
physician  writes  me  as  follows :  "My  patient,  Mrs.  C.,  age 
45,  had  for  the  past  five  years  been  suffering  with  headache 
and  epilepsy.  These  fainting  spells  made  their  first  appear- 
ance after  a  miscarriage  and  have  kept  increasing  in  number 
until  it  was  not  unusual  for  her  to  have  six,  eight  or  even 
more  a  day.  Various  remedies  were  tried  without  much 
effect  until  I  put  her  on  your  Thyro-Ovarian  Co.  and 
the  results  have  been  most  surprising.  The  patient  tells 
me  she  has  not  had  one  attack  since  starting  this  treatment, 
which  naturally  pleases  me  very  greatly."  Evidently  this 
patient  had  a  well-defined  dysovarism  which,  when  treated, 
so  modified  the  chemistry  and  nervous  susceptibility  that 
the  attacks  were  controlled. 

Success  in  Certain  Cases  of  Epilepsy.  As  some  of  my 
friends  know,  I  have  been  interested  for  years  in  what 
might  be  termed  "experimental  organotherapy",  and  the 
most  important  part  of  my  work  has  been  the  development 
of  various  pluriglandular  remedies  for  the  treatment  of 
certain  conditions  which  I  felt  sure  were  of  endocrine  origin 
and  involved  several  of  the  ductless  glands  rather  than  the 
most  obviously  disordered  alone. 

One  of  these  formulas  was  intended  to  awaken  the  dor- 
mant growth  and  development  capacity  in  defective  or  back- 
ward children.  Without  going  into  details — which  have  been 
outlined  quite  fully  elsewhere,  as,  for  example,  in  a  fore- 
going chapter  (7) — I  may  say  that  this  preparation  of  an- 
terior pituitary,  thymus  and  thyroid  has  served  unusually 
well  in  modifying  those  aspects  of  these  unfortunate  chil- 
dren which  are  due  to  ductless  glandular  dystrophies. 

Not  infrequently  epilepsy  is  one  of  the  findings  in  these 
cases,  and,  while  it  may  be  purely  "idiopathic",  it  is  found 
sufficiently  often  to  be  considered  as  more  than  coincidental. 
As  a  matter  of  fact,  the  dyscrinism,  i.  e.,  disturbed  func- 
tion of  the  endocrine  organs  as  a  whole,  may  be  just  as 
much  a  cause  of  the  epilepsy  as  of  the  stigmata  and  develop- 
mental difficulties.  The  thyroid  and  the  pituitary  repeatedly 
have  been  charged  with  bringing  about  conditions  which 


ENDOCRINE  EPILEPSY  241 

favor  epilepsy,  if,  indeed,  their  dysfunction  may  not  be  the 
actual  cause. 

At  all  events,  this  formula  for  defective  children — 
— Antero-Pituitary  Co.  (Harrower) — was  used  in  a  number 
of  this  type  of  cases  in  whom  epilepsy  was  also  present,  and 
we  were  both  surprised  and  delighted  to  note  changes  in  the 
severity  and  frequency  of  the  epileptic  attacks. 

After  a  few  months  it  was  considered  worth  while  to  use 
this  same  treatment  in  epilepsy  not  obviously  associated 
with  a  nameable  endocrine  difficulty;  in  other  words,  we 
said  to  ourselves:  "Here  are  cases  of  epilepsy  with  notice- 
able difficulties  known  to  be  the  result  of  endocrine  disor- 
der, and  treatment  directed  at  this  phase  is  helping  the  epi- 
lepsy as  well.  Why  might  not  there  be  a  less  obvious  but 
just  as  real  connection  between  these  glands  and  the  epi- 
leptic syndrome  in  cases  where  the  developmental  or  other 
stigmata  are  not  seen?"  It  was  empirical,  I  admit.  We 
based  our  work  on  reasoning,  rather  than  known  physiology 
(for  we  had  no  way  of  determining  which  glands  were  at 
fault  and  to  what  degree),  and  are  still  being  criticized  in 
some  quarters  for  unscientific  "shotgun"  therapy. 

But,  literally  scores  of  cases  of  epilepsy — not  merely  in 
children,  as  we  had  planned  to  limit  this  therapeutic  test- 
ing, but  in  youths  and  adults  of  both  sexes — have  been  ben- 
efited in  a  remarkable  degree.  The  attacks  have  ceased  alto- 
gether in  many  instances.  In  others,  their  character  has 
been  entirely  changed  and  the  treatment  is  being  continued. 
In  still  others,  especially  in  cases  where  it  seems  quite 
sure  there  is  a  definite  structural  cerebral  lesion,  there  has 
been  no  benefit  worth  mentioning. 

I  have  scores  of  case  reports  that  I  could  mention — names 
can  be  given  if  it  is  desired.  I  have  had  some  experience 
myself,  and  confess  that  in  some  of  the  cases  where  I  felt 
compelled  to  give  this  formula,  I  did  so  with  misgivings,  and 
frankly  told  the  parents  that  it  was  improbable  that  there 
would  be  any  results.  In  every  instance  they  had  come 
expecting  that  whatever  I  might  recommend  would  be  tried 
out  as  a  last  hope ;  and  in  every  case,  so  far,  I  have  secured 
benefit,  even  if  all  were  not  "cured" — though  some  undoubt- 
edly have  had  the  attacks  stayed  now  for  many  months 
where,  before,  they  came  on  several  times  each  day  or  week. 

I  have  already  called  attention  to  the  fundamental  reasons 
for  this,  and  have  quoted  from  authorities  like  Gushing,  Leo- 
pold Levi,  Hertoghe,  Gauthier,  and  others.  It  is  undoubted 

that  there  may  be  a  thyroid  cause  for  the  toxemia  so  corn- 
is 


242  PRACTICAL  ORGANOTHERAPY 

monly  associated  with  epilepsy;  that  there  may  be  a.  definite 
pituitary  cause  also,  and  there  may  be  other  disorders  of  this 
type  needing  attention  in  those  who  also  have  epilepsy. 

How  are  we  to  determine  which  cases  are  suited  for  this 
treatment?  Frankly,  I  do  know  how  to  do  it — in  advance! 
But  is  it  any  the  less  improper  to  apply  pluriglandular  ther- 
apy with  a  fairly  encouraging  prospect  of  results  than  to 
give  bromides? 

Some  Clinical  Reports.  I  know  just  how  some  physicians 
feel  about  clinical  reports — they  discount  them,  refer  to  the 
need  for  "controls"  and  many  won't  listen  to  them  at  all. 
Anyhow  I  am  going  to  pass  along  a  few  unsolicited  reports 
of  cases  treated  with  Antero-Pituitary  Co.  (Harrower). 
Believe  them,  or  not,  as  you  wish. 

The  first  was  published  in  the  New  Orleans  Medical  and 
Surgical  Journal,  and  an  abbreviated  outline  follows:  The 
case  was  so-called  "idiopathic  epilepsy"  and  was  reported 
by  Dr.  J.  E.  Isaacson  at  a  meeting  of  the  staff  of  the  Hotel 
Dieu,  New  Orleans,  held  July  llth,  1921.  The  subject  was 
a  lad  of  sixteen  who  at  one  and  a  half  years  of  age,  while 
suckling,  appeared  to  be  taken  with  a  convulsion.  Similar 
convulsions  occurred  on  and  off  until  he  reached  the  age  of 
five  years,  sometimes  as  many  as  four  or  five  spells  a  day 
being  experienced.  After  observation  and  treatment  by 
various  pediatrists  and  psychiatrists  he  was,  as  a  last  resort, 
sent  to  a  mental  institution  and  placed  in  a  straight  jacket. 
After  one  year's  confinement  there,  he  returned  home  for 
two  months,  subsequently  returning  to  the  institution 
whence,  after  four  months,  he  was  discharged  as  incurable. 

The  case  was  a  most  unusual  one,  in  that  for  four  months 
preceding  the  time  the  patient  was  taken  in  hand  by  Dr. 
Isaacson  he  had  lost  all  control  of  bowel  and  bladder  func- 
tions and  appeared  to  be  in  considerable  pain  judging  from 
the  writhing  movements  and  cries  observed. 

The  physical  examination  revealed  "an  under-developed 
and  poorly  nourished,  white  male  with  facial  characteristics 
of  an  old  man."  Urinalysis,  feces  and  blood  test  (Wasser- 
man)  negative. 

The  way  the  patient  responded  to  the  treatment  imme- 
diately instituted  (viz:  antero-pituitary  body  compound) 
was  really  wonderful.  The  therapy  was  based  on  the  fact 
that  "idiopathic  epilepsy"  is  often  due  to  pituitary  defic- 
iency. Starting  with  an  initial  dose  of  five  grains  of  Antero- 
Pituitary  Co.  (Harrower)  three  times  a  clay,  Pr.  Isaacson 
states  (New  Orleans  Med.  &  Surg.  J.,  Sept.  1921,  p.  210) : 


ENDOCRINE  EPILEPSY  243 

"Strange  and  amazing  as  it  may  appear,  from  the  time  of 
the  administration  of  the  first  twelve  doses,  there  has  been 
an  absolutely  steady  improvement,  which  heretofore  has 
been  unobtained  from  any  and  all  medication.  At  present 
date  (July  12th) ,  the  fourth  month  after  initial  dosage,  said 
patient  is  up  and  about,  having  complete  control  of  all  body 
functions,  and  having  gained  34  pounds  in  weight.  The 
vomiting  has  entirely  disappeared,  the  patient  eats  every- 
thing, including  ant.  pituitary.  Is  able  to  do  the  ordinary 
chores  about  the  house,  run  errands,  and  can  now  write  and 
spell  the  primary  lessons." 

He  concludes  by  urging  a  fairer  consideration  of  treat- 
ment of  this  type  by  his  critical  colleagues  and  stated  that 
there  has  been  no  recurrence  of  the  fits,  where  previously 
four  or  five  a  day  occurred. 

An  Encouraging  Letter.  Quoting  from  another  letter: 
"To  show  you  that  I  believed  in  what  you  were  doing  is 
but  to  mention  that  in  the  last  five  months  I  have  been  using 
your  preparations  and  I  have  practically  cured  nearly  20 
cases  (of  epilepsy)  and  in  general  have  been  meeting  with 
almost  unbelievable  success.  One  case  in  particular  will  in- 
terest you :  I  saw  this  boy  while  he  was  suffering  the  rigors 
of  influenza,  and  after  treating  him  for  this  for  a  few  days, 
his  mother  asked  if  I  would  not  try  to  help  his  epilepsy. 
At  this  time  the  child  was  having  15  to  30  convulsions  a  day, 
both  the  grand  and  petit  mat.  The  situation  did  not  look 
good  to  me,  as  he  had  been  seen  by  nine  nerve  men  who  had 
given  the  mother  no  hope  whatever.  He  had  been  circum- 
cised and  had  had  the  tonsils  and  adenoids  removed  a  year 
prior  and  had  been  on  a  diet  and  bromided  so  that  he  had 
almost  no  life  in  him. 

"I  modified  the  diet,  cleaned  him  out  some  more  and  gave 
one  of  your  combinations,  and  from  the  first  week  of  this 
treatment  to  date,  he  has  had  no  return  of  the  symptoms,  the 
only  trouble  being  that  from  a  pallid  invalid  he  has  changed 
into  the  worst  youngster  in  the  neighborhood !  This  I  con- 
sider my  most  remarkable  case,  for  it  seemed  like  a  miracle 
to  cure  this  child." 

Several  more  from  quite  a  large  number  accumulated 
during  the  years  may  be  added : 

"I  have  been  using  your  products  about  one  year  and 
have  obtained  most  flattering  results.  In  one  case  I  have 
succeeded  in  keeping  off  epileptic  attacks  of  the  most  des- 
perate character  for  a  little  over  a  year,  having  given  com- 
paratively small  amounts  of  Antero-Pituitary  Co.  (Har- 


244  PRACTICAL  ORGANOTHERAPY 

rower)  during  this  time." 

"One  case  of  epilepsy  I  have  had  under  treatment  for 
eleven  years  and  the  Antero-Pituitary  Co.  (Narrower)  is 
the  first  treatment  that  has  given  me  favorable  results. 
Another  important  case  that  I  have  had  under  my  care  for 
six  years  is  doing  splendidly,  and  for  the  first  time  in  all 
these  years  has  had  no  attack  for  three  months." 

"The  surprising  result  I  have  had  with  your  capsules  in 
the  case  of  my  niece  has  made  me  intensely  interested  in 
the  study  of  epilepsy  and  I  now  desire  to  carry  on  some 
scientific  work  with  it.  My  small  experience  with  your 
formula  in  other  cases  besides  my  niece  has  led  me  to  agree 
with  you  that  back  of  epilepsy  is  a  disturbance  in  the  bal- 
ance of  internal  secretions." 

"Amazing  and  strange  as  it  may  seem,  from  the  first  five 
doses — which  were  given  as  charts  in  the  beginning — a 
steady  improvement  has  been  noted  and  now  in  less  than 
two  months  said  patient  is  up  and  about  (out  of  bed  for 
first  time  in  four  months)  has  complete  control  of  all  body 
functions,  gain  of  21  pounds,  no  vomiting,  and  eating  every- 
thing including  Antero-Pituitary  Co.  (Harrower) .  Lastly, 
absolutely  no  'fits'  in  past  three  weeks  whereas  he  formerly 
had  five  to  six  attacks  a  day;  mind  is  clear  and  patient 
rejuvenated." 

Not  a  Panacea.  I  do  not  wish  it  to  be  understood  that  I 
am  recommending  this  formula,  or  any  glandular  extract, 
as  a  "cure"  for  epilepsy  or  anything  else.  I  merely  state 
that  it  has  been  used  with  distinct  benefit  in  a  number  of 
cases;  that  there  is  enough  in  the  literature,  a  small  part 
of  which  I  have  collated  (both  here  and  in  the  second  issue 
of  Narrower' s  Monographs,  already  referred  to),  to  give 
some  sort  of  a  reason  for  this  method  of  treatment,  and, 
finally,  since  the  prospects  are  so  poor  anyway,  and  there  is 
a  chance  from  this  treatment,  why  not  give  it,  since  two  or 
three  doses  a  day  are  not  known  to  have  caused  any 
detrimental  effects  and  certainly  cannot  be  compared  to  the 
use  of  the  bromides?  Unfortunately,  not  every  case  is  go- 
ing to  respond  to  this  treatment,  but  one  single  success  will 
outweigh  a  hundred  failures. 

The  usual  dose  for  small  children  is  two  five-grain  doses 
a  day,  while  to  children  above  five  years,  two  or  three  a  day 
is  proper.  Individuals  with  well-defined  thyroid  insufficiency 
may  need  additional  thyroid  extract.  It  is  useless  to  start 
this  treatment  unless  it  is  accompanied  by  proper  dietetic, 
hygienic,  and  especially  eliminative,  treatment.  It  must  be 


NOCTURNAL  ENURESIS  245 

continued  for  months,  and  I  am  in  the  habit  of  prescribing 
this  formula  for  four  out  of  every  five  weeks. 

Conclusions.  To  put  it  succinctly:  Epilepsy  has  been 
entirely  cured  by  the  administration  of  Antero-Pituitary  Co. 
(Harrower) .  It  is  going  to  be  again — often,  I  hope. 

I  urge  the  following  points : 

(1)  A  reasonable  attitude. — Organotherapy  does  not  se- 
date over-irritable  cells,  and,  hence,  cannot  take  the 
place  of  bromides  for  this  particular  purpose;  also, 
it  is  only  likely  to  be  of  value  in  those  cases  where 
there  is  indeed  an  endocrine  element  present ; 

(2)  Persistence. — Treatment  should  not  be  started  un- 
less the  parents  agree  to  follow  it  for  at  least  six 
months ; 

(3)  Detoxication. — By  every  known  method — dietetic 
hygienic  and  medicinal. 


SECTION  V.    CHAPTER  13 
NOCTURNAL  ENURESIS 


There  are,  perhaps,  a  dozen  references  in  the  literature 
indicating  that  clinical  experience  has  convinced  various 
writers  that  nocturnal  enuresis  has  an  endocrine  aspect. 

Leonard  Williams'-  Ideas.  In  his  interesting  book,  "Minor 
Maladies,"  Leonard  Williams,  of  London,  calls  attention  to 
the  above  point  in  the  following  words :  "As  the  child  pro- 
gresses in  years,  deficiency  in  thyroid  secretion  may  reveal 
itself  in  various  ways.  One  of  the  most  dramatic  and  alarm- 
ing is  the  production  of  night  terrors.  I  do  not  pretend  to 
be  able  to  explain  the  association  between  these  unpleasant 
ebullitions  and  a  deficiency  of  thyroid  essence  in  the  cir- 
culation, but  I  can  most  positively  affirm  that  they  rapidly 
disappear  under  the  influence  of  thyroid  extract.  I  have 
already  shown  that  nocturnal  enuresis  ('Adenoids,  Noctur- 
nal Enuresis  and  the  Thyroid  Gland,'  London  1909,  Bale, 
Sons  and  Danielsson,  Ltd.) ,  though  it  may  own  other  causes, 
such  as  phimosis  or  intestinal  worms,  is  in  the  vast  majority 
of  cases  caused  by  thyroid  inadequacy  and  is  readily  curable 
by  the  administration  of  thyroid  extract." 

This  same  writer  has  published  several  other  articles 
lending  emphasis  to  his  opinion  that  there  is  a  decided  thy- 
roid side  to  many  cases  of  nocturnal  enuresis,  and  if  the 


246  PRACTICAL  ORGANOTHERAPY 

physician  will  consider  carefully  the  thyroid  aspects  of  his 
case,  often  other  proofs  will  be  forthcoming  and  the  treat- 
ment will  not  be  directed  alone  at  the  bed-wetting,  but  at 
the  complete  syndrome  of  which  it  is  believed  the  enuresis 
is  but  a  part.  It  may  be  well  to  go  into  a  little  more  detail 
in  regard  to  the  thyroid  basis  of  nocturnal  enuresis.  It  is 
well  known  that  many  children  with  definite  stigmata  of 
hypothyroidism,  do  not  have  good  control  over  their  uri- 
nation, and  especially  during  sleep.  It  is  also  known  that 
many  of  the  children  who  are  backward  or  in  the  large 
class  called  "children  requiring  special  attention,"  have  as 
one  of  their  symptoms  this  nocturnal  enuresis.  When  a 
child  is  run-down  and  especially  depleted  from  a  sympa- 
thetic nervous  standpoint,  this  symptom  is  likely  to  be  seen. 

Hertoghe's  Bladder  Desquamation  Theory.  In  addition 
to  Leonard  Williams,  who  has  already  been  quoted,  Eugene 
Hertoghe,  of  Antwerp,  and  Leopold  Levi,  of  Paris,  both  have 
written  convincing  articles  assuming  a  definite  thyroid 
cause  for  bed-wetting.  Hertoghe  has  explained  this,  per- 
haps, as  intelligently  as  any.  He  says  that  in  fairly  well- 
defined  forms  of  hypothyroidism  there  is  a  marked  tendency 
to  cellular  infiltration.  This  does  not  limit  itself  to  the  skin, 
as  in  myxedema,  but  involves  among  other  parts  of  the  body 
the  mucosal  covering  of  the  bladder.  These  squamous  cells 
become  infiltrated  and,  therefore,  die  more  readily  and  are 
desquamated  into  the  bladder,  causing  an  increased  amount 
of  cellular  debris  in  the  urine  (which  may  be  found  by 
microscopic  examination)  and  a  more  decided  irritability  of 
the  recently  denuded  bladder  walls  to  the  urine  that  may  be 
present.  This  naturally  causes  an  irritability  of  the  blad- 
der and  favors  the  nocturnal  enuresis. 

Other  explanations  have  been  given  for  the  relation  be- 
tween the  thyroid  gland  and  bed-wetting  in  children,  and  it 
may  not  always  be  possible  in  advance  to  determine  that 
a  given  child  has  a  definite  thyroid  cause  for  the  trouble 
which  may  bring  it  to  your  attention.  In  harmony  with 
Leopold  Levi's  suggestion,  it  is  well  to  give  cases  of  this 
kind  a  course  of  thyroid  therapy  in  the  hope  that  this  may 
modify  the  presumably  underlying  dysthyroidism  and  at 
the  same  time  favor  control  of  the  enuresis.  This  is  in  har- 
mony with  my  suggestions  in  the  chapter  entitled  "Diag- 
nostic Organotherapy"  (Section  II,  Chapter  6) ,  in  which  I 
urge  the  application  of  a  suitable  glandular  feeding  in  the 
expectation  of  acquiring  information  in  regard  to  the  basic 
cause  of  the  trouble,  as  well  as  attempting  to  benefit  it. 


NOCTURNAL  ENURESIS  247 

Leopold  Levi  recommends  the  beginning  of  the  opother- 
apy  of  such  cases  with  approximately  a  quarter  to  half  of 
a  grain  of  thyroid  a  day.  I  have  frequently  recommended 
a  quarter  of  a  grain  three  times  a  day,  and  increased  this 
dose  sometimes  to  li/2  or  even  2  grains  a  day. 

In  children  that  are  definitely  abnormal  the  principal  ef- 
fort should  be  made  to  modify  the  fundamental  endocrine 
imbalance  in  order  that  they  may  be  more  nearly  normal, 
and  this  we  have  been  in  the  habit  of  doing  with  Antero- 
Pituitary  Co.  (Harrower),  which  has  been  discussed  quite 
fully  in  previous  articles  and  especially  in  the  chapter  en- 
titled "Glandular  Therapy  for  Defective  Children." 

The  Posterior  Pituitary  Principle.  There  are  a  number 
of  references  in  the  literature  which  indicate  that  the  prin- 
ciple of  the  posterior  pituitary  lobe  has  a  tonic  influence  on 
the  bladder  muscular  cure  and  has  been  used  successfully 
in  the  control  of  nocturnal  enuresis.  Injections  of  Liquor 
Hypophysis,  U.  S.  P.,  frequently  have  been  given  with  defi- 
nite control  over  bed-wetting  and  for  reasons  that  are  not 
always  easy  to  explain.  Perhaps  there  is  a  deficient  tonicity 
of  the  bladder  muscles,  and  especially  those  muscles  con- 
cerned in  the  retention  of  the  urine;  and  the  well-known 
musculotonic  influence  of  this  principle  has  served  to  bring 
about  a  better  turn  and,  therefore,  increased  the  facility  of 
control  of  the  urine  in  the  bladder. 

I  recall  the  case  of  a  student  nurse,  age  20,  who  had 
never  overcome  the  habit  of  her  childhood.  It  was  so  morti- 
fying to  her  that  she  was  in  a  serious  nervous  state  as  a 
result  of  the  obvious  emotional  factors.  I  was  consulted 
by  one  of  the  hospital  faculty — advised  Liq.  Hypophysis 
"on  the  off-chance  that  it  might  help  her"  and  six  injec- 
tions cured  her  entirely. 

Provided  the  external  conditions  are  ruled  out  of  the 
diagnosis,  that  is  to  say,  if  there  is  no  local  condition,  no 
intestinal  worm,  no  phimosis,  no  central  nervous  lesion, 
and  provided,  generally  speaking,  that  the  case  has  been 
brought  into  the  prospectively  endocrine  class,  the  thyroid 
feeding  should  be  given  for  at  least  a  month. 

A  Suggestive  Routine  Procedure.  There  is  a  little  scheme 
that  I  have  suggested  which  may  be  well  worth  passing 
along.  If  it  is  presumed  that  there  is  a  thyroid  or  pituitary 
basis  for  conditions  of  this  kind,  prescribe  one  hundred 
Thyroid  Co.  (Harrower)  No.  9,  representing  one  half  grain 
of  the  desiccated  thyroid  substance.  Give  one  such  dose  each 
day  for  a  week,  usually  with  the  morning  meal.  During  the 


248  PRACTICAL  ORGANOTHERAPY 

second  week,  give  one  at  each  of  two  meals,  and,  during 
the  third  week,  give  one  at  each  of  the  three  meals.  Dur- 
ing the  fourth  week  of  this  clinical  test,  give  four  doses  a 
day,  and  during  the  fifth  week  omit  the  thyroid  entirely. 
During  this  entire  period  have  the  patient,  or  parents,  make 
a  record  of  conditions  as  they  show  themselves,  and  note 
if  during  any  of  these  weeks  there  is  any  special  change 
in  the  bed-wetting.  Watch  for  the  tolerance  to  the  thyroid, 
and  thus  discover  the  optimal  dosage  required.  At  the  end 
of  this  five-week  period,  if  there  is  no  change  at  all,  another 
plan  may  be  suggested.  Secure  a  package  of  Liquor  Hypo- 
physis (Harrower) — a  15-mil.  vial — and  inject  hypodermi- 
cally  five  minims,  every  other  day,  for  a  week.  During  the 
second  week,  give  eight  minims  at  each  dose,  daily.  At 
the  end  of  the  second  week  it  will  be  possible  to  pass  judg- 
ment upon  the  efficacy  of  this  measure  and,  if  there  has 
been  some  benefit,  it  may  be  continued.  Otherwise,  we  will 
conclude  from  our  seven  or  eight  weeks  of  experimental 
organotherapy  that  these  two  endocrine  aspects,  at  least, 
evidently  are  not  at  the  bottom  of  the  difficulty. 

Quite  often  the  thyroid  therapy  alone  exerts  a  very  satis- 
factory influence  upon  a  nocturnal  enuresis  that  has  proved 
resistant  to  other  methods  of  treatment.  Leonard  Williams 
is  very  decided  in  his  statements  about  this.  On  the  other 
hand,  a  number  of  cases  that  do  not  respond  to  thyroid 
therapy  have  been  cleared  up  with  the  posterior  pituitary 
principle  as  suggested.  Success  in  the  treatment  of  condi- 
tions of  this  kind  by  organotherapy  involves  the  pinning 
down  of  the  difficulty  to  an  endocrine  cause,  for  organo- 
therapy will  not  modify  a  nocturnal  enuresis  of  some  ana- 
tomical, mechanical  or  chemical  basis;  and  here,  again,  is 
an  instance  of  the  diagnostic  organotherapy  already  re- 
ferred to. 


SECTION  V.    CHAPTER  14 
HEMOGLOBIN:    A  REMEDY  FOR  ANEMIA 


One  of  the  oldest  forms  of  organotherapy  was  repre- 
sented by  the  treatment  of  various  affections  by  using  fresh 
blood  from  various  animals  and  birds.  As  late  as  twenty 
or  twenty-five  years  ago,  this  treatment  of  anemia,  and  es- 
pecially tuberculosis,  was  quite  a  common  prescription ;  and, 


HEMOGLOBIN  IN  ANEMIA  249 

despite  their  repugnance,  the  patients  made  their  daily 
trips  to  the  abattoirs  in  order  to  drink  the  blood  warm  from 
the  animal.  The  development  of  a  technique  in  organo- 
therapy, and  especially  vacuum  methods  of  drying,  have 
put  an  end  to  all  this,  and  repurified  oxyhemoglobin  in 
powder  or  solution  is  now  available. 

Some  Physiological  Considerations.  Hemoglobin,  or  oxy- 
hemoglobin, is  the  respiratory  element  in  the  red  blood  cell 
and  is  the  principal  source  of  iron  in  the  body.  The  rich- 
ness of  the  hemoglobin  in  the  cell,  and  consequently  the 
richness  of  the  iron  in  the  blood,  controls  the  "respiratory 
value"  of  the  blood  or,  in  other  words,  determines  its  value 
as  a  means  of  taking  oxygen  from  the  air  to  the  various  tis- 
sues and  bringing  back  carbon  dioxide  for  elimination.  Mod- 
ifications in  the  hemoglobin  content  in  the  blood  necessarily 
must  be  of  serious  moment,  and  the  condition  known  as 
anemia  is  not  merely  a  disturbance  of  the  number  of  blood 
cells  but  of  their  hemoglobin  content. 

For  many  years,  metallic  iron  (reduced  iron)  and  various 
salts  of  iron  have  been  recommended  for  their  "hematinic" 
value,  and  among  the  better  known  of  these  is  Blaud's  mass, 
containing  carbonate  of  iron;  ferric  chloride,  usually  given 
in  the  form  of  the  tincture,  and  a  large  number  of  so-called 
"organic"  forms  of  iron  in  which  iron  has  been  combined 
with  proteids  like  casein,  albumin,  etc. 

A  great  deal  of  experimental  work  has  been  done  to  de- 
termine the  physiological  availability  of  the  iron  in  various 
iron  preparations,  and  it  has  been  shown  that  the  majority 
of  practically  all  of  them,  both  organic  and  inorganic,  is 
largely  passed  out  in  the  stools  unchanged  or,  at  least,  in 
the  form  of  sulphide  of  iron.  Despite  this,  iron  is  still  a 
watchword  in  the  treatment  of  anemia,  and  the  development 
of  our  information  regarding  hemoglobin  as  a  substitute  for 
other  forms  of  iron  has  shown  that  it  is  a  remarkable  rem- 
edy and  superior  to  the  long  list  of  iron  preparations,  both 
in  and  out  of  the  pharmacopeias.  Our  practical  knowledge 
of  the  clinical  value  of  hemoglobin  preparations  is  largely 
the  result  of  clinical  experiences  of  Hay  em,  Dujardin-Beau- 
metz  and  Simon,  three  eminent  Frenchmen,  and  there  is 
ample  literature  upon  the  subject. 

Castellino's  Clinical  Conclusions.  The  following  conclu- 
sions have  been  set  down  in  a  comprehensive  study  of  this 
subject,  which  was  published  a  number  of  years  ago  by 
Castellino.  They  still  apply  with  equal  force  today: 

"The  absorption  of  hemoglobin  is  brought  about  very 


250  PRACTICAL  ORGANOTHERAPY 

rapidly.  It  is  well  tolerated,  even  in  subjects  suffering 
from  digestive  difficulties,  and  never  produces  phenomena 
of  intolerance,  such  as  vomiting,  constipation,  epigastric 
discomfort,  pyrosis,  etc.  Its  favorable  action  upon  the  re- 
constitution  of  the  blood  is  shown  in  the  increase  of  the 
number  of  red  cells,  of  their  resistance,  weight,  color,  di- 
ameter, and  their  capacity  to  attain  a  normal  appearance. 

"Under  the  influence  of  hemoglobin  therapy,  the  general 
health  is  benefited,  the  appetite  is  increased,  the  nutrition 
is  better,  and  there  is  an  increase  in  weight  and  strength, 
with  a  simultaneous  disappearance  of  the  various  subjec- 
tive phenomena  of  anemia.  In  cases  of  secondary  anemia, 
as  in  cancer,  leukemia,  etc.,  there  is  a  benefit  obtainable 
from  the  use  of  hemoglobin,  but  the  result  is  transitory. 

"Hemoglobin  is  indicated  especially  in  those  cases  of 
anemia  in  which  there  are  serious  digestive  disturbances 
and  malnutrition,  as  well  as  in  convalescence  following  feb- 
rile disorders  and  chronic  disease.  In  order  to  secure  the 
most  satisfactory  results,  it  is  advisable  to  give  a  minimum 
daily  dose  of  20  centigrams.  The  therapeutic  indications 
may  be  given:  Post-hemorrhagic  anemia,  metrorrhagia, 
anemias  of  infectious  origin,  chlorosis,  tuberculosis  in  a 
special  manner,  chronic  forms  of  paludism,  and,  above  all, 
in  conditions  of  an  acute  character  where  there  is  a  marked 
destruction  of  the  red  cells." 

The  Routine  Value  of  Hemoglobin.  From  the  above  re- 
marks, it  will  be  clear  that  hemoglobin  indeed  has  a  place 
in  the  routine  practice  of  medicine,  for  it  is  a  proteid-iron 
molecule  that  is  easily  assimilable  and  non-constipating.  It 
is  the  most  satisfactory  form  of  iron  available  in  thera- 
peutics and  is  used  and  recommended  as  a  rational  substi- 
tute for  various  better  known  preparations  of  iron,  and  re- 
peatedly has  been  claimed  to  be  unsurpassed  for  the  admin- 
istration of  iron  by  mouth. 

Personally,  I  am  inclined  to  believe  that  hypodermic  in- 
jections of  cacodylate  of  iron  may  be  a  better  hematinic 
measure  in  the  so-called  "acute  anemias" — those  rapidly  de- 
veloped conditions  of  anemia  due  to  various  toxic  and  nutri- 
tional derangements.  In  such  cases,  however,  the  injections 
properly  may  be  supplemented  by  hemoglobin,  which  is  a 
much  more  convenient  remedy  in  conditions  where  hypo- 
dermics are  not  acceptable  and,  especially,  where  the  anemia 
is  not  sudden  nor  so  immediately  serious. 

According  to  Potter  (Materia  Medica,  13th  Ed.),  "the  ac- 
tion of  iron  is  to  cause  an  increase  of  the  hemoglobin  of 


HEMOGLOBIN  IN  ANEMIA  251 

the  red  blood  corpuscles,  either  by  its  direct  conversion  into 
an  ingredient  of  hemoglobin  or  by  stimulating  the  func- 
tional activity  of  the  hemopoietic  organs,  or  perhaps  by 
both  means  combined.  This  power  of  enriching  the  red 
blood  corpuscles  by  hemoglobin  is  essentially  the  whole  con- 
stitutional action  of  iron." 

Naturally  it  was  presumed  by  those  who  were  interested 
in  hemoglobin  as  a  remedy  of  prospective  merit,  that  it 
would  be  immediately  absorbed  as  such  and  be  available  di- 
rectly and,  as  in  the  case  in  all  "new  remedies,"  these  state- 
ments were  immediately  denied.  Much  bandying  back  and 
forth  of  words  ensued  in  French  literature,  and,  after  a 
number  of  years,  Paul  Carnot,  now  Professor  of  Therapeu- 
tics in  the  University  of  Paris,  remarked  in  his  book  "Opo- 
therapie"  (page  92),  that  "the  clinical  results  appear  in 
some  degree  to  be  in  contradiction  to  the  theoretical  objec- 
tions which  we  have  just  formulated."  In  other  words, 
whether  hemoglobin  is  digested  and  changed  or  not,  or 
whether  it  gets  into  the  red  cell  with  slight  modification,  is 
a  technical  matter  which  does  not  enter  into  consideration 
when  clinical  results  are  definitely  obtained,  and  hemo- 
globin, without  a  doubt,  is  one  of  the  best  forms  of  organic 
iron  obtainable. 

A  Broader  Therapeutic  Effect.  It  is  believed  that  hemo- 
globin represents  not  merely  a  good  means  of  administer- 
ing organic  iron  for  its  ferruginous  value,  but  according  to 
several  observers,  hemoglobin  actually  exerts  a  homostimu- 
lant  effect  comparable  with  the  effects  of  other  organothera- 
peutic  products,  i.  e.,  it  definitely  stimulates  the  hemopoietic 
organs,  just  as  thyroid  extract  stimulates  the  thyroid  gland 
or  adrenal  substance  stimulates  the  adrenals.  This  may  or 
may  not  be  the  case ;  but  it  has  been  proved  time  and  again 
that  iron  in  the  form  of  hemoglobin  is  not  so  quickly  elim- 
inated from  the  body  as  other  organic  forms  of  iron,  which, 
of  course,  are  superior  to  the  mineral  forms  of  which  the 
ferrous  carbonate  mass  is  the  type. 

It  is  claimed  by  some  investigators  that  the  eosinophile 
count  is  an  index  of  the  regenerative  capacity  of  the  organ- 
ism and  especially  of  the  medullary  substance  of  the  long 
bones  where  red-cell  production  has  its  chief  seat.  With 
this  in  mind,  it  is  interesting  to  note  that  Metzner  found 
the  eosinophile  count  nearly  two  and  a  half  times  as  great 
in  a  series  of  hemoglobin-fed  animals  as  compared  with 
several  controls.  Certainly  in  simple  anemias,  as  well  as 
in  chlorosis  and  secondary  anemias  in  lesser  degree,  the 


252  PRACTICAL  ORGANOTHERAPY 

hemoglobin  index  is  decidedly  raised  following  a  course  of 
hemoglobin  by  mouth. 

Hemoglobin  with  Synergists.  Among  the  earliest  special 
experimental  formulas  made  in  this  laboratory  was  a  pre- 
paration containing  hemoglobin  and  spleen,  and  one  of  the 
most  interesting  reports  that  has  ever  come  to  me  followed 
the  use  of  this  formula  in  a  case  of  anemia  in  an  Oakland 
hospital.  The  hemoglobin  figure  was  as  low  as  15  per  cent. 
(Dare)  and  the  red  cell  count  between  700,000  and  800,000 
per  cu.  mm.  Naturally  there  was  a  loud  hemic  murmur  and 
a  considerable  chance  that  the  heart  would  give  out,  so  suit- 
able stimulation  was  given  for  this  as  well  as  the  special 
hemoglobin  formula.  To  make  a  story  which  lasted  several 
weeks  occupy  only  a  few  lines,  the  patient  was  discharged 
with  a  hemoglobin  index  of  75  per  cent.,  and  the  red  cell 
count  was  4,500,000.  After  a  good  many  experiments,  we 
hit  upon  the  stock  formula  which  we  call  No.  13,  Hemo- 
globin Co.  (Harrower),  each  dose  of  which  represents  6 
grains  of  a  mixture  containing  4  grains  of  repurified  desic- 
cated hemoglobin  from  the  blood  of  the  steer,  1  grain  of 
desiccated  spleen  substance  and  */2  grain  of  nucleinic  acid. 
The  repurified  hemoglobin  is  reinforced  by  the  addition  of 
nucleinic  acid  (nuclein)  and  spleen  substance,  for  several 
good  reasons.  First  of  all,  iron  does  not  have  any  special 
effect  upon  leucocytosis.  Blaud's  mass  will  not  affect  the 
white  cell  count,  nor,  for  that  matter,  will  hemoglobin ;  but 
nuclein  (originally  prepared  from  the  thymus)  is  the  most 
remarkable  stimulant  of  leucocytic  activity  known  and  is 
used  in  conditions  where  an  enhanced  white  cell  service 
would  be  acceptable.  There  are  many  reports  of  its  value, 
and  many  of  them  draw  attention  to  the  noticeable  resis- 
tance-increasing effects  of  nuclein.  It  fits  in  splendidly  with 
hemoglobin,  and  to  my  mind  the  combination  is  made  still 
better  by  adding  a  suitable  dose  of  spleen  substance,  since 
this  product  exerts  a  good  influence  in  practically  all  the 
forms  of  anemia. 

Hemoglobin  Co.  (Harrower)  may  be  given  in  doses  of 
four  to  six  a  day,  after  meals.  It  is  a  sensible,  reconstruc- 
tive treatment  in  post-operative,  post-febrile  and  post-par- 
tum  conditions,  and  is  suggested  as  a  routine  prescription 
in  all  anemias  where  the  first  thought  is  "iron." 

A  number  of  physicians  have  desired  to  combine  the  ad- 
renal-supportive formula,  Adreno-Spermin  Co.,  with  hemo- 
globin so  that  it  would  be  better  suited  for  those  asthenic 
individuals  whose  difficulties  are  aggravated  by  anemia  and 


HIGH  BLOOD  PRESSURE  253 

an  associated  nutritional  factor.  For  such,  the  No.  68, 
Spermin-Hemoglobin  Co.  (Narrower),  is  suggested,  since 
it  combines  these  measures  in  a  very  satisfactory  manner. 
A  preparation  like  this  combines  several  purely  physio- 
logical stimulative  effects,  all  of  which  are  especially  needed 
following  any  severe  illness  whether  acute  or  chronic,  in 
young  or  old.  This  will  be  found  far  superior  because  more 
rational  than  the  old-fashioned  tonics  like  Beef,  Iron  and 
Wine,  or  I.  Q.  &  S.,  and  it  will  augment  the  reestablishment 
of  those  essential  functions  which  have  suffered  from  the 
fever  and  toxemia  from  which  the  patient  is  convalescing. 


SECTION  V.    CHAPTER  15 
REDUCING  HIGH  BLOOD  PRESSURE 


Undoubtedly  the  endocrine  glands  are  related  to  certain 
functional  disturbances  of  the  arterial  tension.  While  it 
is  still  true  that  the  problem  of  the  control  of  hypertension 
is  a  complex  one,  involving  several  factors  which  cannot 
be  considered  here,  the  fog  of  years  is  lifting,  and  clinical 
experience  is  showing  us  the  real  facts  in  this  case.  It  is 
just  as  obvious  that  the  two  distinct  types  of  increased 
blood-pressure — functional  and  organic— offer  two  very 
different  therapeutic  problems.  Individuals  with  a  func- 
tional hypertension  are  suffering  from  more  or  less  tem- 
porary physiological  derangements  resulting,  among  other 
things,  from  conditions  which  irritate  or  unduly  stimulate 
the  so-called  "pressor  mechanism,"  while  in  the  other  class, 
mechanical  or  anatomical  factors  are  involved  and  there  is 
almost  invariably  some  real  pathology.  It  should  be  clear 
that  an  individual  with  arteriosclerosis,  renal  impermea- 
bility, cardiac  hypertrophy,  and  other  structural  changes, 
would  not  be  in  the  same  category  with  an  individual  whose 
thyroid  was  inactive  or  whose  adrenal  system  was  over- 
driven, and  naturally,  the  prospects  in  the  treatment  of 
such  organic  cases  are  not  nearly  so  good. 

Organic  Functional  Forms.  The  tendency  has  leaned  to 
the  study  of  these  organic  forms  of  high  blood-pressure, 
though,  in  point  of  fact,  the  more  easily  modified  functional 
conditions  are  much  more  common.  Recently  a  prominent 
Dutch  internist  said  that  we  have  no  grounds  for  the  as- 
sumption that  high  blood-pressure  is  always  secondary  to 


254  PRACTICAL  ORGANOTHERAPY 

heart,  kidney  or  vascular  disease.  It  has  no  more  signifi- 
cance than  the  discovery  of  a  sclerosis  or  hardening  01  a 
normally  soft  organ.  He  continues :  "Because  we  can  meas- 
ure the  blood-pressure,  we  have  paid  too  much  attention  to 
it  and  hidden  our  ignorance  behind  the  term  'essential  hy- 
pertension.' The  rise  in  blood-pressure  is  merely  one  ele- 
ment of  a  morbid  series  which  have  to  be  regarded  as  a 
whole." 

I  propose  to  discuss  this  matter  briefly  and  essentially 
from  the  standpoint  of  the  general  practitioner,  and  espe- 
cially from  the  aspects  of  the  endocrine  causes  and  the  or- 
ganotherapeutic  treatment. 

From  the  every-day  standpoint,  there  are,  as  stated,  two 
distinct  types  of  increased  blood-pressure,  i.  e.,  functional 
and  organic.  Individuals  with  the  former  have  a  high  ten- 
sion as  a  result  of  temporary  or  permanent  conditions  which 
irritate  or  unduly  stimulate  the  organs  whose  function  it 
is  to  control  the  mechanism  of  the  circulation.  In  the  other 
class,  the  tension  may  not  be  so  high,  but  the  patients  are 
found  to  be  suffering  from  arteriosclerosis,  renal  disease, 
cardiac  hypertrophy  and  other  structural  changes  which 
may  be  both  the  cause  and  effect  of  the  increased  tension. 

There  are  several  classifications  of  disorders  in  which 
changes  are  prominent  in  the  blood  pressure.  For  the  mo- 
ment we  are  not  interested  in  these.  If,  however,  one  classi- 
fies the  hypertensives  into  the  two  general  categories  just 
mentioned,  the  functional  must  be  considered  as  the  result 
of  disordered  chemistry  and  may  respond  to  well-directed 
efforts  to  modify  this;  while  the  organic,  which  are,  gen- 
erally speaking,  only  amenable  to  palliative  treatment  cal- 
culated to  antagonize  incidental  factors  rather  than  ac- 
tually soften  the  vessels,  reduce  the  size  of  the  heart  and 
bring  about  structural  changes  for  the  better,  have  a  similar 
etiology  but  are  further  advanced. 

Overstimulation  of  the  Adrenals.  Functional  hyper- 
tension many  times  may  be  due  to  a  temporary  overstimu- 
lation  of  the  adrenal  glands.  Despite  an  occasional  state- 
ment to  the  contrary,  the  consensus  of  opinion  places  the 
adrenal  glands  in  the  position  of  exerting  a  very  definite 
control  over  the  muscular  tonicity  of  the  vascular  mechan- 
ism and,  consequently,  of  the  arterial  pressure.  In  addi- 
tion to  a  good  deal  of  experimental  data,  there  has  been 
much  clinical  evidence  to  show  that  factors  which  stimulate 
the  adrenals  first  increase  their  blood-pressure-raising  ca- 
pacity, and,  when  these  glands  have  become  overstimulated 


HIGH  BLOOD  PRESSURE  255 

and  played  out,  reduce  this  factor  and  consequently  permit 
a  subnormal  systolic  pressure.  In  view  of  this,  the  treat- 
ment of  this  form  of  high  blood-pressure  should  involve 
the  removal  of  as  many  of  these  adrenal  irritating  factors 
as  possible,  as  well  as  the  physiological  antagonizing  of  a 
hyperfunctioning  adrenal  system. 

According  to  Louis  Klein,  (Therap.  Notes,  May,  1921) 
the  hormone  of  the  adrenal  medulla — adrenin — controls  the 
contraction  of  the  blood-vessels.  A  corollary  of  this  propo- 
sition is  that  the  presence  of  high  blood-pressure  may  indi- 
cate adrenal  hypersecretion.  In  the  study  of  a  case  of  hy- 
pertension without  cardiovascular  or  renal  foundation,  the 
logical  procedure  is  to  determine  which  glands,  if  any,  have 
become  sufficiently  abnormal  to  derange  the  endocrine 
chain  and  thus  cause  the  adrenals  to  put  out  an  actually  or 
relatively  excessive  amount  of  their  principle.  The  solu- 
tion of  this  problem  may  not  always  be  easy,  but,  once  ar- 
rived at,  it  repays  the  student  for  his  efforts.  The  glands 
most  frequently  at  fault  are  the  thyroid,  the  pituitary  and 
the  gonads.  According  to  this  writer,  "Occasionally  the 
etiological  factor  is  an  uncomplicated  hyperadrenia." 

Treatment  for  Excessive  Adrenal  Functioning.  To  mod- 
ify successfully  an  excessive  adrenal  functioning,  first  re- 
move all  infectious  foci  or  sources  of  toxemia,  thus  lessen- 
ing the  irritating  character  of  the  blood  as  it  passes  through 
the  adrenals. 

Second,  if,  indeed,  others  of  the  glands  of  internal  secre- 
tion, because  of  some  abnormal  relationship,  are  causing 
an  irritation  of  the  adrenal  system,  this  dyscrinism  deserves 
to  be  studied  and  modified  as  best  we  may  be  able.  Finally, 
since  it  has  been  definitely  determined  that  the  pancreas 
and  the  adrenals  are  antagonists,  any  hyperadrenia  would 
involve  either  a  lessened  pancreatic  function  or  encourage 
us  to  increase  pancreatic  function  so  that  the  antihormone 
produced  in  the  Langerhansian  cells  of  the  pancreas  might 
be  increased  in  the  expectation  of  overruling  at  least  a  part 
of  the  excessive  adrenalism.  It  is  presumed  by  many  in- 
vestigators that  diabetes  is  a  condition  due  to  a  deficient 
internal  secretion  of  the  pancreas,  and  since  von  Noorden 
has  called  this  "the  brake  to  the  sugar  mechanism,"  many 
times  individuals  with  pancreatic  insufficiency  have  an  asso- 
ciated hyperadrenia  with  an  unusually  sensitive  sympa- 
thetic system,  glycosuria,  and  also  a  functional  high 
blood-pressure.  Obviously,  the  treatment  of  these  cases,  in 
addition  to  such  indicated  regulation  of  diet  and  hygiene,  is 


256  PRACTICAL  ORGANOTHERAPY 

the  encouragement  of  the  pancreas  gland,  which  can  be 
done  very  satisfactorily  by  the  use  of  certain  pancreas  prep- 
arations. 

The  Endocrine  Side  of  Hypertension.  Not  a  few  intern- 
ists now  give  routine  consideration  to  the  endocrine  glands 
in  their  study  of  these  cases,  while  ten  years  ago  they  were 
hardly  given  a  thought. 

Functional  hypertension  many  times  is  traceable  to  some 
disorder,  usually  of  a  toxic  character,  which  is  affecting  the 
production  of  the  internal  secretions.  For  instance,  adrenal 
irritability  is  certainly  a  prolific  cause  of  hypertension. 
Then  again,  there  is  an  ovarian  form  which  is  due  to  or  asso- 
ciated with  the  menopause;  and  this  is  one  of  the  best- 
known  forms  of  functional  hypertension — the  so-called 
"post-climacteric  hypertension." 

The  conviction  is  rapidly  growing  that  ductless  glandular 
dysfunction  is  responsible  for  a  majority  of  these  purely 
functional  cases;  and,  therefore,  that  their  consideration 
from  this  standpoint  may  be  the  beginning  of  a  successful 
therapy.  Are  not  the  adrenal  glands  (and  the  endocrine 
glands  which  cooperate  with  them)  charged  with  the  con- 
trol of  the  sympathetic  system,  and,  particularly,  with  the 
regulation  of  the  cardio-vascular  functions?  Should  they 
not,  then,  receive  full  consideration  in  the  clinical  investi- 
gation of  abnormal  conditions  in  blood  pressure,  whether 
high  or  low? 

A  persistently  low  blood-pressure  directs  attention  to  the 
adrenals,  and  progressive  students  of  clinical  medicine  think 
at  once  of  Addison's  disease  or  the  less  serious  form  of 
functional  hypoadrenia  when  a  systolic  tension  of  100  mm. 
or  below  is  encountered.  But  as  yet  we  have  not  given  suffi- 
cient thought  to  these  glands  as  causes  of  high  blood-pres- 
sure, though  undoubtedly  increased  adrenal  functioning  is  as 
capable  of  causing  it  as  hypoadrenia  is  a  cause  of  the  oppo- 
site. 

We  are  accustomed  to  get  immediate  and  lasting  results 
from  the  use  of  pluriglandular  therapy  in  cases  of  hypoten- 
sion. Why  not  apply  the  same  fundamental  principles  in 
the  opposite  condition? 

Neutralizing  Endocrine  Irritability.  Many  students  of 
endocrinology  have  long  realized  the  comparatively  greater 
difficulty  of  controlling  conditions  of  hypercrinism  than  hy- 
pocrinism,  i.  e.,  of  reducing  excessive  endocrine  activity  as 
compared  with  stimulating  or  augmenting  deficient  gland 
function.  Just  as  the  control  of  hyperthyroidism  is  more 


HIGH  BLOOD  PRESSURE  257 

difficult  than  the  control  of  hypothyroidism,  so  it  is  a  more 
difficult  proposition  to  reduce  blood-pressure  of  internal  se- 
cretory origin  than  it  is  to  raise  it.  _  However,  we  do  not 
fold  our  hands  in  the  organotherapeutic  treatment  of  hyper- 
thyroidism,  and  really  find  much  good  in  suitable  gland  ex- 
tracts (see  Chapter  6  of  this  section) ;  and  I  urge  that  we 
investigate  further  the  possibilities  of  the  use  of  "antago- 
nistic hormones"  when  we  have  to  control  the  form  of  high 
blood-pressure,  which  is  beginning  to  be  believed,  and 
rightly  so,  to  be  the  result  of  hypercrinism.  Here  the  in- 
creased adrenal  function,  the  abnormal  sympathetic  irrita- 
bility and  the  conditions  that  go  with  these  states,  may  be 
amenable  to  organotherapy;  and  there  has  accrued  much 
advantage,  in  some  cases  at  least,  in  carefully  applying  what 
little  we  know  of  the  subject. 

Heretofore  our  therapeutic  efforts  have  been  largely  lim- 
ited to  the  removal  of  all  forms  of  toxemia  —  intestinal, 
dietetic  and  focal — and  this  is  preeminently  right,  for  the 
purins,  the  toxic  protein  wastes  of  amino-acid  nature,  and 
the  poisons  that  we  love  to  swallow  (caffeine,  for  instance) , 
must  be  rigidly  eliminated.  Parenthetically,  I  must  mention 
the  occasional  seemingly  proper  foodstuffs  which,  because 
of  idiosyncrasy  or  "protein-sensitization,"  cause  more  or 
less  serious  chemical  reactions  in  the  body.  These  should 
be  found  out  and  their  use  stopped.  All  these  poisonous 
substances  must  be  disposed  of  by  solution  and  elimination, 
by  neutralization  or  by  well-advised  prescribing  by  the  phy- 
sician, because  they  are  adrenal  irritants,  and  thus  keep 
up  a  continual  stimulation  of  the  blood-pressure  control. 

Attention  also  should  be  called  to  the  emotional  causes 
of  adrenal  irritability  which  have  been  brought  to  our  notice 
by  Prof.  Walter  B.  Cannon's  discoveries,  which  indicate 
that  there  is  a  relationship  between  emotional  stimuli  and 
adrenal  excitation.  How  many  times  has  worry  aggravated 
a  case  of  hypertension?  How  many  times  have  we  seen 
blood-pressure  changes  as  a  result  of  severe  grief  or  shock? 

So  we  routinely  detoxicate,  we  neutralize,  we  starve 
within  reason,  we  purge  as  much  as  we  dare;  and  we  ac- 
complish something,  for  the  pressure  may  drop,  sometimes 
quite  encouragingly.  We  have  removed  a  part  of  the  cause, 
and  the  adrenals  have  a  better  chance  to  resume  their  nor- 
mal service.  Why  not  go  a  step  further  and  assist  in  the  re- 
establishment  of  the  disturbed  hormone  balance?  May  this 
not  be  done  by  increasing  those  hormones  which  are  known 
to  antagonize  the  adrenals  ?  This  seems  eminently  rational. 

17 


258  PRACTICAL  ORGANOTHERAPY 

Sometimes  our  prophylactic  treatment  just  outlined 
causes  the  pressure  to  drop  a  notch  or  two  and  it  may  hover 
around,  say,  180  or  190  mm.  The  regimen  becomes  a  bit 
too  strenuous,  or  too  monotonous,  the  patient  tires  of  the 
diet,  the  medicine  and  the  other  treatment,  and  the  pres- 
sure begins  to  increase  again.  It  is  here  that  organotherapy 
may  render  the  most  efficient  service. 

Pancreas  Gland  a  Remedy  for  Hypertension.  Pancreas 
substance — the  total  gland,  including  the  internal  secretory 
cells  in  the  tail  and  the  acinous  portion — is  an  anti-adrenal 
remedy,  and  there  are  a  number  of  references  in  the  litera- 
ture, especially  in  that  published  in  Italy,  indicating  that 
the  pancreas  treatment  of  functional  hypertension  has  been 
successful  in  certain  cases,  and,  as  we  will  shortly  see,  it 
may  be  enhanced  materially  by  associating  it  with  other 
cooperative  endocrine  products. 

Great  emphasis  must  be  laid  upon  the  necessity  for  con- 
trolling factors  which  keep  up  a  continual  irritation  of  the 
adrenals.  It  is  absurd  to  expect  that  physiologic  antago- 
nism to  hyperadrenia  will  suffice.  Every  factor  likely  to 
irritate  the  adrenal  glands,  including  all  the  matters  men- 
tioned elsewhere,  should  be  regulated  simultaneously,  and 
pancreas  therapy  must  be  considered  only  as  an  associated 
cooperative  therapeutic  factor. 

My  own  view  is  that  pancreatic  organotherapy  favors  the 
control  of  functional  hypertension,  both  by  increasing  in- 
testinal digestion  as  a  result  of  its  effect  upon  the  pancreatic 
external  secretion,  and  by  its  direct  anti-adrenal  action  so 
well  described  in  the  literature  and  so  often  proved  by  ex- 
periment and  clinical  application.  This  is  due  to  the  homo- 
stimulant  effect  on  the  internal  secretory  capacity  of  the 
pancreas,  which  has  as  two  of  its  responsibilities  the  bal- 
ancing of  the  adrenal  medullary  principle  and  the  regulation 
of  carbohydrate  metabolism.  Parenthetically,  this  reminds 
us  of  the  relation  of  pancreatic  diabetes  to  hypertension  and 
the  condition  of  adrenal  sensitization  (shown  up  by  Loewi's 
test)  in  hyperadrenia  or  reduced  pancreatic  endocrine  ac- 
tivity; but  this  is  too  large  a  subject  for  consideration  here. 
It  is  mentioned  again  in  Section  IV,  Chapters  11  and  12. 

To  repeat:  The  pancreas  very  definitely  opposes  the  ad- 
renals ;  and  several  authors  have  spoken  well  of  the  depres- 
sor virtues  of  pancreas  organotherapy.  We,  therefore,  will 
attempt  to  increase  pancreatic  activity  as  best  we  may,  and 
will  hope  to  see  results  which  show  that  adrenal  hyperac- 
tivity  is  being  reduced.  Often  the  hypertension  accompany- 


HIGH  BLOOD  PRESSURE  259 

ing  this  condition  is  reduced  in  a  salutary  manner,  and  a 
diminution  of  40  to  60  millimeters  is  no  uncommon  thing. 

Influence  of  Gonads  on  Blood  Pressure.  The  sex  glands 
or  gonads,  especially  the  ovaries,  exert  some  subtle  influence 
upon  factors  which,  when  uncontrolled,  cause  changes  in 
the  blood-pressure.  This  seems  to  be  particularly  true  in 
women  at  the  change  of  life.  The  character  of  the  high 
blood-pressure,  and  especially  of  its  response  to  the  regu- 
lation of  disturbed  endocrine  function  at  this  period,  has 
caused  many  pleasing  changes  in  an  abnormal  systolic  ten- 
sion, which  confirm  its  essentially  functional  character  as 
well  as  its  responsiveness  to  suitable  organotherapy.  The 
normal  decline  of  gonad  function  in  both  sexes  evidently  is 
compensated  for  by  a  readjustment  in  other  endocrine  or- 
gans and  is  quite  commonly  connected  with  hypertension. 
When  these  readjustments  are  not  made  as  thoroughly  or 
as  quickly  as  they  should  be,  symptoms  of  the  imbalance 
soon  make  their  appearance,  and  again  we  find  an  involve- 
ment of  the  adrenal  mechanism.  Undoubtedly  there  is  an 
intimate  connection  between  the  adrenals  and  the  gonads, 
with  not  merely  a  functional  hypertension,  but  other  evi- 
dences of  adrenal  disturbance.  Carey  Culbertson,  of  Chi- 
cago, (Surg.  Gyn.  &  Obs.,  Dec.,  1916,  xxiii,  667),  K.  I. 
Sanes,  of  Pittsburg,  (Am.  Jour.  Obs.,  Jan.,  1916,  xxix,  7), 
and  others,  have  stated  in  no  uncertain  terms  that  the  in- 
stability of  the  pressor  mechanism  at  the  menopause  is  con- 
nected definitely  with  ovarian  insufficiency,  and  ovarian 
therapy  has  been  efficacious  in  modifying  the  excessive 
systolic  pressure  in  these  cases.  Cummings,  of  Los  An- 
geles (Calif.  St.  Jour.  Med.,  1919,  xvii,  373),  is  also  con- 
vinced that  increased  blood-pressure,  hot  flushes  and  other 
circulatory  and  nervous  manifestations  at  the  menopause, 
are  definitely  endocrine  in  origin.  In  addition  to  the  bro- 
mides, he  recommends  various  endocrine  extracts  for  their 
favorable  influence  upon  functional  hypertension  of  this 
type. 

It  has  been  repeatedly  stated  that  a  part  of  the  service 
rendered  to  the  organism  by  the  sex  hormones  relates 
to  intracellular  oxidation.  Hence,  the  functional  recession 
of  gonad  activity  naturally  would  tend  to  favor  deficient 
metabolism  and,  consequently,  a  toxemia  which  must  be 
just  as  irritating  to  the  adrenals  as  any  other  form  of  tox- 
emia such  as  has  been  referred  to  above. 

Ovarian  Dysfunction — a  Cause  of  Hypertension.  Atten- 
tion has  been  called  to  the  frequency  with  which  a  high 


260  PRACTICAL  ORGANOTHERAPY 

tension  may  follow  the  menopause.  There  are  several  in- 
teresting reports  of  the  value  of  ovarian  organotherapy  in 
hypertension  of  this  type.  Most  comprehensive  among 
these  is  the  paper  by  Carey  Culbertson,  already  mentioned, 
in  which  it  is  shown  that  vasomotor  disturbances  of  the 
menopause  are  largely  endocrine  in  origin — due  to  the  with- 
drawal of  the  ovarian  hormone  and  the  discord  which  neces- 
sarily results  for  a  time.  These  regulations  and  the  results 
from  the  dominance  of  this  secretion,  or  that,  are  gone  into 
in  detail  in  Culbertson's  article.  Hypertension  is  the  rule 
in  these  cases ;  in  fact,  it  was  present  in  all  but  four  of  the 
whole  series  which  he  reported.  The  fundamental  cause  is 
believed  by  Culbertson  to  be  adrenal  hyperactivity  and,  per- 
haps, a  disturbance  of  the  pituitary  following  the  removal 
of  the  influences  undoubtedly  due  to  ovarian  endocrine  func- 
tion. Based  upon  this  idea,  ovarian  or  luteal  homostimula- 
tion  should  tend  to  neutralize  these  pressor  substances, 
thereby  reducing  the  tension,  and  this  seems  to  be  the  case, 
since  Culbertson  reports  good  results  in  many  such  cases. 

Sanes,  of  Pittsburgh  (Trans.  A,  Gyn.  Assn.,  1918),  dis- 
cussing vasomotor  instability  at  the  menopause,  also  speaks 
well  of  the  organotherapeutic  regulation  of  hypertension. 

The  Regulative  Effect  of  the  Ovarian  Hormone.  In  this 
connection  an  editorial  which  appeared  in  the  Journal  of 
the  American  Medical  Association  of  Nov.  27,  1920,  already 
published  in  some  of  our  literature,  and  which  we  repro- 
duce again  below,  lends  especial  emphasis  to  the  impor- 
tance of  ovarian  dysfunction  as  a  cause  of  functional  high 
blood-pressure,  and  there  can  be  no  doubt  that  it  is  possi- 
ble, by  means  of  suitable  organotherapy,  to  bring  down 
dangerously  high  blood-pressure  without  harm  to  the  pa- 
tient and  without  recourse  to  what  we  usually  call  "drug 
action."  Here  it  is : 

"It  has  long  been  realized  that  age  is  a  factor  which  must 
be  taken  into  consideration  in  giving  an  answer  as  to  what 
constitutes  the  normal  arterial  blood-pressure.  There  are 
also  variations  that  seem  to  be  associated  with  sex.  In  ex- 
amining the  numerous  data  collected  by  Alvarez  at  the  Uni- 
versity of  California,  it  appears  that  women  before  the 
menopause  represent  almost  exclusively  a  type  endowed 
with  a  comparatively  low  blood-pressure.  There  is  far  greater 
uniformity  and  less  variation  in  the  blood-pressure  readings 
1  of  large  numbers  of  them  than  is  true  of  men  at  the  same 
periods  of  life.  Alvarez  (Arch.  Int.  Med.,  October,  1920) 
has,  therefore,  suggested  that  perhaps  the  ovary  is  in  some 


HIGH  BLOOD  PRESSURE  261 

way  able  'to  cover  up  or  hold  latent  the  tendency  to  hyper- 
tension which  we  will  presume  the  women  inherit  equally 
with  the  men.'  When  the  ovarian  function  fails,  therefore, 
the  natural  tendency  for  the  appearance  of  higher  arterial 
pressures  soon  makes  itself  appreciated.  Perhaps  this  hy- 
pothesis will  help  to  explain  the  assertion  sometimes  made 
that  hypertension  often  develops  early  in  women  who  show 
signs  of  insufficient  ovarian  function,  such  as  scanty  and 
painful  menstruation,  sexual  anesthesia,  male  distribution 
of  body  hair,  infantile  uterus,  etc.  At  any  rate,  the  phe- 
nomea  of  hypertension  appear  to  be  suppressed  in  women 
as  long  as  the  ovaries  function  well.  On  the  other  hand, 
the  statistics  show  that  the  large  increase  in  the  incidence 
of  hypertension  comes  ten  years  later  in  men  than  in  wo- 
men. Apparently,  Alvarez  concludes,  a  strenuous  life  has 
less  to  do  with  this  disease  than  has  the  quieting  down  of 
the  sexual  functions." 

Placenta — A  Pituitary  Antagonist.  In  reply  to  a  recent 
question  put  to  me  as  to  whether  placental  extract  is  useful 
in  high  blood  pressure  at  the  menopause,  I  stated  that  while 
this  substance  had  been  used  experimentally  by  a  number  of 
physicians  for  treatment  of  high  blood-pressure,  I  did  not 
feel  that  I  could  answer  affirmatively,  as  I  could  not  speak 
from  actual  experience.  Klein,  of  Detroit,  in  a  recent  paper 
states:  "Many  endocrine  high  blood  pressure  cases  are 
ascribable  to  some  change  in  the  function  of  the  pituitary. 
We  know,  of  course,  how  an  excess  of  pituitary  secretion 
might  operate  in  raising  the  tension.  These  cases  are  easily 
recognized  because  they  frequently  have  an  associated 
glycosuria  due  to  the  low  sugar  tolerance.  The  specific 
antagonist  of  the  pituitary  is  the  placenta."  He  then  pro- 
ceeds to  recommend  a  desiccation  of  placenta  substance,  5 
grains  three  times  a  day,  for  men  as  well  as  women,  and 
states  that  "It  meets  this  indication."  Bandler,  of  New 
York,  too,  in  his  recent  book  "The  Endocrines,"  makes  the 
following  statement:  "Placental  extract  some  day  may  be 
used  to  inhibit,  if  possible,  the  post-pituitary.  The  placenta, 
which  is  probably  responsible  for  the  toxemia  of  pregnancy, 
is  developed  partly  from  the  spermatozoa  contributed  by  the 
partner.  This  condition,  therefore,  may  possibly  be  allied 
to  anaphylaxis."  And,  of  course,  it  is  known  that  anaphyl- 
axis — or  protein  sensitization — is  a  factor  in  causing  func- 
tional high  blood  pressure.  None  of  these  last-mentioned 
conditions,  however,  are  definitely  related  to  the  menopause, 
which,  after  all,  is  what  was  uppermost  in  my  correspon- 


262  PRACTICAL  ORGANOTHERAPY 

dent's  mind  in  framing  his  question.  In  this  connection  my 
remarks  under  the  heading  "The  Pluriglandular  Treatment 
of  Hypertension"  should  be  noted.  There  is  much  to  be 
done  in  the  lines  of  experimental  organotherapy.  Some  of 
our  friends  say  that  it  is  improper  to  acquire  some  idea 
from  an  article,  or  statement,  and  test  it  on  a  patient.  Is 
it  not  equally  improper,  however,  to  deny  to  a  person  a  pos- 
sible benefit  from  a  certain  method  of  treatment  which  may 
have  been  tried  many,  many  times  before,  merely  because 
you  are  not  thoroughly  acquainted  with  it  and  able  to  use 
it  "scientifically"?  At  all  events,  I  can  safely  say  that 
many  hundreds  of  physicians  have  used  Thyro-Pancreas 
Co.  with  Ovary  in  women  with  functional  high  blood-pres- 
sure, and  especially  in  that  particular  kind  of  hypertension 
which  accompanies  the  menopause.  In  men,  a  similar  prep- 
aration, containing  spermin  instead  of  ovary*  is  used  with 
comparatively  good  results.  The  dose  of  either  of  these 
preparations  is  one  at  each  meal,  and  at  bedtime,  continued 
for  a  minimum  of  three  months. 

The  Detoxicating  Influence  of  the  Thyroid.  Another  im- 
portant phase  of  this  very  large  subject  must  be  mentioned 
ever  so  briefly.  The  thyroid  is  concerned  chiefly  in  the 
control  of  the  detoxicating  mechanism  of  the  body.  It  is 
the  great  oxidizing  agent;  and  when  its  work  is  below  par 
(as  one  would  expect  it  to  be  in  individuals  who  suffer  from 
the  functional  hypertension  under  discussion),  conditions 
favorable  to  the  production  of  high  blood-pressure  are  al- 
lowed to  establish  themselves.  This  gives  us  a  partial 
explanation  of  the  good  results  reported  in  some  cases  of 
hypertension  which  have  been  treated  with  thyroid  extracts 
alone.  In  such  cases,  small  doses  of  thyroid  may  be  given 
with  advantage  for  months,  and  the  "deaminizing"  effect 
of  the  thyroid  hormone,  explained  by  Slosse,  of  Brussels, 
undoubtedly  is  helpful. 

The  Thyroid  Gland  and  Metabolism.  The  thyroid  gland 
is  largely  responsible  for  the  processes  of  metabolism,  and, 
consequently,  when  it  is  functionally  inefficient  there  may 
ensue  an  accumulation  of  wastes  which  serve  in  a  mechani- 
cal way  to  raise  the  blood-pressure.  Recently,  Llewellys 
Barker,  of  Baltimore,  (Ohio  St.  Jour.  Med.,  Oct.,  1920,  xvi, 
709),  stated  that  high  blood-pressure  appears  to  depend 
chiefly  upon  a  narrowing  of  the  lumina  of  the  arterioles  in 
the  so-called  precapillary  areas,  and  that  it  is  first  func- 
tional and  caused  by  hypertonus  of  the  arterial  musculature, 
but  later  may  assume  a  partly  organic  character  as  a  result 


HIGH  BLOOD  PRESSURE  263 

of  changes  in  the  arteries  themselves.  Barker  believes  that 
different  types  of  chronic  hypertension  probably  represent 
different  changes  in  the  development  of  the  same  funda- 
mental process  which  may  advance  with  varying  rapidity 
and  with  varied  associated  involvement  of  the  cardiovascu- 
lar, renal,  cerebral,  and  other  structures  in  different  cases. 

Hypothyroidism  Causes  Cellular  Infiltration.  There  is  an 
especial  interest  in  this  connection  when  one  realizes  that 
hypothyroidism  uniformly  causes  a  cellular  infiltration  that 
is  a  result  of  deficient  cell  chemistry.  The  accumulation  of 
the  wastes  causes  a  swelling  of  the  cells,  based  upon  the 
physical  reasons  of  osmosis,  for  it  is  clear  that  these  solids 
draw  into  the  cell  an  increased  amount  of  fluid  in  order  to 
dissolve  them,  and  the  cells  become  puffed  up  with  their 
own  waste  products — just  exactly  as  we  see  it  so  decidedly 
in  myxedema,  and  presumably  this  takes  place  just  as  much 
in  the  precapillary  areas  above  referred  to  as  in  other 
parts  of  the  body.  So,  aside  from  disturbances  in  the  de- 
toxicated  mechanism,  due  to  thyroid  insufficiency,  there  is 
also  this  mechanical  favoring  of  a  high  tension.  This  seems 
to  be  a  very  good  reason  why  the  use  of  thyroid  extract 
sometimes  makes  such  a  change  for  the  better  in  certain 
functional  high  blood-pressures.  The  consequent  enhance- 
ment of  cellular  chemistry,  the  removal  of  the  accumulating 
effete  materials,  and  the  lessening  of  this  mechanical  oppo- 
sition to  circulation  in  the  remote  ends  of  the  circulatory 
mechanism,  is,  I  believe,  an  important  factor  in  the  thyroid 
aspects  of  high  blood-pressure. 

Hypothyroidism,  Infiltration  and  Hypertension.  Towards 
the  end  of  1920  there  appeared  in  the  Medical  Record  a 
contribution  from  my  pen,  entitled  "Hypothyroidism,  In- 
filtration and  Hypertension."  In  his  letter  to  me  accept- 
ing this  article  for  publication,  the  editor  was  kind  enough 
to  say:  "Your  conception  of  the  relations  between  thyroid 
insufficiency,  infiltration  and  high  blood-pressure  is  brilliant, 
and  I  am  sure  that  it  is  true." 

I  have  often  wondered  why  thyroid  so  often  reduces  high 
blood-pressure,  and  especially  in  certain  cases,  and  I  am  sur- 
prised that  this  particular  aspect  of  the  matter  was  not 
thought  of  before.  Since  the  influence  of  the  thyroid  gland 
upon  the  chemistry  of  the  body  is  of  such  paramount  im- 
portance, it  is  worth  while  to  consider  it  in  the  functional 
or  essential  forms  of  high  blood-pressure.  The  combina- 
tion of  thyroid — to  antagonize  the  cellular  infiltration  and 
its  mechanical  obstruction  to  capillary  circulation;  pan- 


264  PRACTICAL  ORGANOTHERAPY 

creas — to  directly  neutralize  adrenal  irritablity  (because 
it  has  been  shown  that  the  pancreas  hormone  is  the  physio- 
logical antagonist  of  the  chromaffin  hormone),  and  favor 
a  better  alimentary  condition,  thereby  lessening  the  tox- 
emia which  irritates  the  adrenals ;  and  ovary — to  modify  the 
imbalance  so  commonly  connected  with  functional  high 
blood-pressure  in  women,  specially  at  the  change  of  life, 
is  a  very  valuable,  progressive  step. 

Thyroid  Extract  Recommended.  There  are  many  refer- 
ences in  the  literature,  too,  to  the  therapeutic  advantages  of 
thyroid  extract  in  certain  forms  of  essential  high  blood- 
pressure,  and  as  Klein  puts  it,  "if  the  diagnosis  is  doubtful 
a  few  days  of  thyroid  treatment  will  quickly  elicit  the  de- 
sired information."  He  reports  having  recently  seen  three 
patients,  all  of  whom  had  a  systolic  blood-pressure  ranging 
from  180  to  210  mm.,  who  were  made  perfectly  comfortable 
and  whose  blood-pressures  were  reduced  below  160  in  a 
short  time  with  no  other  medication  than  one-sixth  of  a 
grain  of  thyroid  extract  three  times  a  day.  I  want  to  call 
special  attention  to  the  frequency  with  which  this  form  of 
high  blood-pressure  occurs  in  patients  who  are  obese.  It 
seems  clear  to  me  that  these  patients  are  not  oxidizing  with 
sufficient  rapidity  the  products  of  destructive  metabolism, 
and,  therefore,  because  of  the  deficient  stimuli  from  the 
thyroid  and  associated  glands,  there  accumulate  certain 
protein  wastes  which  overburden  the  emunctories  and 
thereby  directly  raise  arterial  tension,  not  merely  from  the 
cause  just  mentioned  but  from  the  direct  irritating  influence 
of  these  products  upon  the  adrenal  mechanism  previously 
referred  to.  Thus  the  thyroid  aspect  of  functional  high 
blood-pressure  is  extremely  important  since  the  adminis- 
tration of  thyroid  in  suitable  cases,  in  addition  to  favoring 
a  better  chemistry  in  the  manner  just  suggested,  is  also  an 
indirect  means  of  antagonizing  adrenal  irritability  and,  con- 
sequently, is  a  cooperative  measure  of  considerable  value  in 
conjunction  with  pancreas. 

Blood  Pressure  in  Hyperthyroidism.  Sir  James  Barr 
(Practitioner,  June,  1921,  p.  387),  says  that  in  hyperthy- 
roidism  the  mean  arterial  pressure  is  lower  than  normal 
owing  to  lessened  peripheral  resistance  due  to  dilation  of 
the  arterioles  and  diminished  viscosity  of  the  blood.  The 
capillary  and  venous  pressure  rise,  however,  and  this  leads 
to  a  large  supply  of  blood  being  furnished  to  the  heart,  an 
increased  systolic  output  and  a  raised  systolic  pressure ;  but 
owing  to  a  low  peripheral  resistance,  there  is  a  great  fall  in 


HIGH  BLOOD  PRESSURE  265 

the  pressure  gradient  with  a  relatively  low  diastolic  pressure. 
This  combination  of  high  systolic  and  low  diastolic  pressure 
causes  longitudinal  straining  of  arteries,  and  leads  to  waste 
of  energy,  for  the  heart  is  overloaded  and  its  energy  chiefly 
expended  during  systolic  and  not  stored  up  in  the  elastic 
walls  of  the  arteries.  In  hyperthyroidism  there  is  defi- 
cient vascular  tone;  hence  the  hypertrophy  and  dilation  of 
the  heart  with  elongation  of  arteries  often  seen  in  this  con- 
dition. Adrenal  extract,  by  improving  vascular  tone  is, 
therefore,  valuable  in  hyperthyroidism.  It  may  here  be 
stated,  that  this  is  one  of  the  reasons  why  Pancreas  Co. 
(Harrower)  contains  adrenal  substance  and  is  often  used 
with  real  success  in  hyperthyroidism. 

Importance  of  the  Endocrine  Balance.  Quite  recently  in  an 
editorial  note  in  Clinical  Medicine  (December,,  1920)  the 
following  statement  appears :  "Endocrine  balance  is  vital ; 
when  it  is  disturbed  the  organism  is  ailing.  Does  one  mem- 
ber of  the  endocrine  chain  lag  or  for  any  reason  fail  to  func- 
tion, then  another,  in  the  absence  of  a  normal  restraint 
exercised  by  an  opposing  gland,  renews  its  efforts  with  pro- 
vocative increase  of  secretion.  A  striking  example  of  this  is 
given  by  Bandler  (N.  Y.  Med.  Jour,,  June  5, 1920,  cxi,  972) . 
He  shows  us  that  the  thyroid  gland  during  pregnancy  is  un- 
der a  strain  in  consequence  of  the  extra  work  it  has  to  do. 
The  same  is  true  during  lactation,  and  occasionally  symp- 
toms arise  that  are  referable  to  an  unopposed  adrenal  ac- 
tion, such  as  high  blood-pressure,  flushes,  palpitation,  nerv- 
ousness, and  so  on.  The  prevention  or  control  of  these 
symptoms  is  accomplished  by  thyroid  therapy,  and  Bandler 
reports  excellent  results  from  the  administration  of  small 
doses  of  thyroid  gland." 

Each  of  these  three  organotherapeutic  measures  is 
especially  helpful  in  the  type  of  cases  mentioned.  It  hap- 
pens that  many  of  these  cases  overlap,  and  it  is  not  over- 
stating things  to  say  that  many  have  all  three  of  these 
factors  simultaneously  present.  At  all  events,  it  is  a  very 
common  thing  to  find  hypothyroidism  at  the  menopause  (it 
is  said  that  ninety  per  cent,  of  all  cases  of  myxedema  occur 
in  women  and  ninety-five  per  cent,  of  these  occur  in  women 
in  the  decade  between  forty  and  fifty!).  The  hypothyroid- 
ism and  hypo-ovarism  which  one  expects  to  find  under  such 
circumstances  routinely  are  accompanied  by  an  adrenal 
irritability  for  reasons  previously  mentioned  and  conse- 
quently, as  I  see  it,  the  treatment  of  functional  high  blood- 
pressure  at  the  change  of  life  is  best  accomplished  by  the 


266  PRACTICAL  ORGANOTHERAPY 

addition  to  the  routine  detoxicating  and  regulating  meas- 
ures of  a  pluriglandular  therapy  involving  the  ovaries,  the 
pancreas,  and  reinforcing  these  with  small  doses  of  thyroid. 

Pluriglandular  Therapy  of  Hyperthyroidism.  For  four 
years  we  have  been  working  upon  this  particular  problem, 
and  not  merely  have  I  been  successful  in  reducing  a  number 
of  the  functionally  high  blood-pressures,  ranging  from  180 
to  300  mm.,  but  many  of  my  colleagues  have  seen  fit  to  fol- 
low my  suggestions,  and  the  reports  which  have  come  to 
this  office  prove  that  this  is  a  rational  and  advantageous 
measure.  Provided  the  increased  tension  is  functional,  it 
may  be  reduced  many  times  in  a  very  encouraging  manner 
by  following  this  method  of  treatment. 

Thyro-Pancreas  Compound  with  Ovary  (Harrower)  con- 
tains two  grains  of  desiccated  total  pancreas  gland  (not  pan- 
creatin,  two  grains  of  total  ovarian  substance,  and  one 
twelfth  of  a  grain  of  U.  S.  P.  thyroid.  One  such  dose  is 
given  at  each  meal  and  at  bedtime,  or  four  times  a  day,  for 
a  minimum  period  of  two  months  and  in  some  instances 
considerably  longer,  especially  in  women  where  there  are 
other  evidences  of  endocrine  imbalance. 

In  the  treatment  of  functional  high  blood-pressure  in 
men,  a  similar  preparation  is  almost  as  efficacious.  This  is 
called  Thyro-Pancreas  Co.  with  Spermin  (Harrower) .  The 
formula  is  identical  with  the  one  mentioned  above,  save  that 
the  ovarian  element  is  replaced  with  spermin  from  the  in- 
terstitial cells  of  Leydig.  The  dosage  is  also  the  same. 

Both  of  these  pluriglandular  formulas  have  been  tested 
many  thousands  of  times.  The  aggregate  of  results  has 
been  good,  and  while  many  cases  have  been  treated  in  whom 
there  was  really  no  functional  endocrine  basis  for  the  high 
blood-pressure,  still  the  average  has  sufficed  to  convince  us 
of  the  possibilities  of  this  matter.  These  formulas  are  well 
worthy  of  consideration ;  since  high  blood-pressure,  whether 
functional  or  organic,  is  a  dangerous  proposition.  I  have 
yet  to  find  any  reports  of  detrimental  by-effects.  Certainly 
such  measures  are  more  rational  than  the  nitrates  or  other 
vasodilating  drugs,  for  it  seems  that  something  of  a  real 
physiological  character  is  being  accomplished  by  the  organo- 
therapy. 

Warning  Against  a  Wrong  Attitude.  It  should  be  em- 
phasized that  our  consideration  of  this  subject  and  the  treat- 
ment of  these  individuals  from  the  endocrine  standpoint 
always  should  be  a  part  of  a  well-regulated  regimen.  While 
it  is  true  that  certain  investigators  prefer  to  regulate  their 


HIGH  BLOOD  PRESSURE  267 

treatment  so  that  they  can  acquire  definite  information  as 
to  the  responsiveness  of  the  patient  to  their  treatment,  or, 
in  other  words,  to  the  efficacy  of  their  remedy,  I  am  very 
much  opposed  to  this  attitude  in  a  clinical  way,  for  this 
reason :  I  consider  that  the  patient's  interests  come  before 
my  own,  that  while  it  would  be  very  interesting  to  know 
certain  reactions  of  the  patient  to  a  certain  line  of  treat- 
ment, and  to  acquire  as  much  diagnostic  information  in  this 
way  as  possible,  it  is  wrong  to  deny  the  patient  the  benefit 
of  whatever  may  be  fundamentally  advisable  until  we  are 
satisfied  that  a  certain  measure  is  good  or  not  as  the  case 
may  be.  In  other  words,  if  there  is  indeed  an  eliminative 
aspect  to  a  given  case,  this  should  be  treated.  If  the  diet 
needs  to  be  regulated,  it  should  be  regulated.  If  there  is 
an  endocrine  dysfunction  of  several  ductless  glands,  they 
should  be  treated  together  and  every  measure  calculated  to 
render  service  to  the  individual  should  be  instituted,  and 
instituted  simultaneously,  if  possible. 

Clinical  Results  from  this  Method.  Some  of  the  results 
have  been  most  encouraging.  From  my  own  records,  I  can 
give  several  figures :  A  woman  of  50  came  with  a  B.  P.  (sys- 
tolic) of  245.  After  one  month  it  was  190  and  after  two 
months  it  was  172.  She  has  evidently  much  improved. 
Another  woman  at  the  menopause  took  the  capsules  (S.  F. 
No.  30)  for  about  a  month;  the  tension  was  reduced  from 
185  mm.  to  155  mm.  A  gentleman  followed  my  suggestion 
for  less  than  a  month,  i.  e.,  he  cut  out  coffee,  took  an  alophen 
pill  every  other  night  (on  general  principles)  and  the  S.  F. 
No.  29  q.  i.  d.  His  tension  was  reduced  from  185-190  mm. 
to  140  mm.  Still  another  case,  using  the  same  formula, 
showed  a  reduction  of  40  points  when  the  seemingly  irre- 
ducible minimum  was  190  mm.  Many  reports  have  been 
made  to  me  personally  and  by  letter.  I  can  mention  a  few 
of  these  figures  off-hand:  210-160;  180-135;  200-145;  185- 
140;  and  220-175.  All  these  figures  refer  to  the  systolic 
pressure,  for  it  happens  that  functional  high  blood-pressure 
usually  concerns  more  the  systolic  than  the  diastolic  figures. 

We  cannot  definitely  promise  any  uniform  results  from 
the  treatment,  for  the  value  of  this  method  depends  a  great 
deal  upon  the  conditions  present  and,  especially,  the  respon- 
siveness of  the  endocrine  glands.  The  raison  d'etre  is  quite 
logical,  and  the  percentage  of  results  is  high  enough  to  raise 
our  hopes.  It  is  a  measure  which  to  my  way  of  thinking  far 
outclasses  the  nitrites,  iodides  and  other  half-way  measures 
routinely  used  in  this  common  condition. 


268  PRACTICAL  ORGANOTHERAPY 

Conclusions.  To  conclude  this  study,  and  to  sum  up: 

1.  Certain  functional  hypertensive  conditions  deserve  to 
be  considered  from  the  standpoint  of  endocrinology. 

2.  These  cases  should  be  carefully  selected  and  the  or- 
ganic factors  eliminated. 

3.  After  as  thorough  detoxication  and  elimination  as  is 
possible  to  secure,  and  in  conjunction  with  this  treatment 
and  preventive,  dietetic  and  hygienic  measures,  I  suggest 
organotherapy. 

4.  Pancreas  substance  is  indicated.     Thyroid  is  emi- 
nently useful.    Ovary  is  of  decided  value  in  certain  cases. 
Pluriglandular  therapy  has  a  reasonable  basis  and  is  worthy 
of  a  trial. 

The  whole  subject  of  the  treatment  of  functional  high 
blood-pressure  has  been  revolutionized  by  the  development 
of  organotherapy,  and  particularly  pluriglandular  therapy. 
Many  patrons  of  The  Harrower  Laboratory  and  correspond- 
ents of  mine  have  written  enthusiastic  statements  in  regard 
to  the  splendid  reductions  in  blood-pressure  that  have  fol- 
lowed this  method  of  treatment,  and  for  this  reason  Thyro- 
Pancreas  Co.  with  Ovary  (Harrower),  (or  with  Spermin, 
as  the  case  may  be)  is  confidently  recommended.  The 
usual  dose  is  one  at  each  meal  and  on  retiring.  Treatment 
should  be  kept  up  for  at  least  three  months. 


SECTION  V.    CHAPTER  16 
ORGANOTHERAPY  IN  ASTHMA 


During  the  three  years  that  we  have  been  experiment- 
ing with  various  organotherapeutic  preparations  in  the 
treatment  of  various  forms  of  asthma  I  have  felt  that  of  all 
the  possibilities  of  results  from  this  type  of  treatment,  the 
results  in  asthma  were  least  dependable.  Unfortunately, 
asthma  is  a  very  complicated  condition,  and  cases  that  ap- 
pear to  be  similar  to  one  another  in  manifestations  really 
differ  materially  in  their  origin.  In  all  references  to  the 
pluriglandular  formula  that  we  have  developed  for  the  treat- 
ment of  asthmatic  patients  we  have  emphasized  the  fact 
that  it  was  experimental.  It  is  a  good  remedy  in  the  right 
kind  of  cases,  and  it  is  practically  impossible  to  determine 
which  cases  are  in  this  category  until  the  remedy  has  been 
applied  for  two  or  three  months.  Most  of  the  individuals 


ORGANOTHERAPY  IN  ASTHMA  269 

who  have  taken  Adreno-Hypophysis  Co.  (Harrower) ,  as 
well  as  their  physicians,  have  adopted  it  in  despair,  since 
they  already  had  tried  many  measures  and  had  failed. 
Naturally,  this  class  of  cases  is  less  likely  to  respond  to  any 
kind  of  treatment  than  more  simple  ones  in  which  the  funda- 
mentals are  not  so  complex,  and  in  spite  of  this  we  have 
had  a  fairly  good  percentage  of  results. 

An  Experimental  Measure.  I  still  feel  that  this  method 
of  treating  asthma  is,  as  already  stated,  experimental,  be- 
cause the  fact  that  various  food  proteins  cause  asthma  in 
suitable  individuals;  that  certain  pollens  and  other  similar 
substances  may  cause  manifestations  akin  to  asthma;  and, 
then,  because  most  of  the  patients  that  have  bronchial 
asthma  have  bronchitis  with  it,  and  there  is  an  absorption 
from  the  focus  of  infection  of  a  considerable  amount  of  the 
bacteria  protein  products  to  which  the  patient  undoubtedly 
is  susceptible,  make  the  prospects  very  indeterminate. 

The  symptoms  of  asthma  have  some  similarity  to  those 
connected  with  endocrine  disturbance,  and  for  some  years  it 
has  been  shown  that  the  distressing  paroxysms  usually  can 
be  promptly  controlled  by  injections  of  from  3  to  10  minims 
of  adrenal  chlorid  solution,  1:1000.  Unfortunately,  the 
effects  are  ephemeral,  and  sometimes  an  effective  dose  of 
adrenalin  causes  a  temporary  vasomotor  spasm  which  is 
quite  uncomfortable.  More  recently  there  have  been  a  num- 
ber of  reports  referring  to  a  combination  of  the  adrenal 
and  posterior  pituitary  solutions  by  hypodermic  injection 
instead  of  adrenalin  alone,  and  it  is  believed  that  the  effects 
of  this  combination  are  more  far-reaching  and  lasting.  It  is 
well  known  that  such  treatment  is  only  symptomatic  and,  of 
course,  it  is  inconvenient,  and  quite  a  number  of  physicians 
have  presumed  that  the  prolonged  administration  of  some  of 
the  products  of  this  character  by  mouth  might  be  success- 
ful likewise.  The  subject  is  still  in  the  experimental  stage, 
and  it  is  hard  to  say  anything  very  definite  about  it. 

The  Endocrine  Aspect  of  Asthma.  Selfridge,  of  San 
Francisco,  has  been  working  on  this  subject  for  some  years 
and  recently  published  an  article  in  the  California  State 
Journal  of  Medicine  (April  and  May,  1919),  reporting  the 
endocrine  findings  in  a  number  of  cases  of  asthma.  These 
seem  to  indicate  that  dyscrinism  is  an  underlying,  causative 
factor  and  that  the  control  of  disorders  of  this  kind  simul- 
taneously may  favor  the  control  of  the  asthmatic  attacks. 
Selfridge  concludes  his  paper  with  some  remarks  worth 


270  PRACTICAL  ORGANOTHERAPY 

quoting  here:  "The  question  of  the  ductless  glands  has 
been  brought  forward  because  we  cannot  see  all  cases,  be- 
longing to  the  different  groups  mentioned,  cured  entirely  by 
the  removal  of  focal  infections  plus  the  injection  of  various 
protein  solutions.  And,  while  we  admit  that  very  many 
cases  may  not  be  benefited  by  the  administration  of  gland 
products  by  mouth,  especially  in  adults,  we  feel  that  the 
recognition  of  gland  deficiency  among  children  particularly, 
who  exhibit  vasomotor  ataxia  and  in  whom  these  sugges- 
tions as  to  treatment  are  followed  out,  may  ultimately  en- 
able us  to  put  into  the  class  of  cured  cases  those  who  other- 
wise might  be  doomed  to  grow  up  as  defectives.'* 

Anterior  Pituitary  Substance  in  Bronchial  Asthma.  A 
series  of  clinical  experiments  which  may  be  of  much  prac- 
tical value  were  carried  out  by  Frederick  Warf  el  in  the  In- 
dianapolis City  Hospital  (Indianapolis  Med.  Jour.,  July, 
1915)  to  investigate  the  possibilities  of  organotherapy  in 
bronchial  asthma.  While  the  administration  of  anterior  pit- 
uitary substance  in  this  condition  was  and  still  is  empirical, 
it  is  well  known  that  this  extract  has  encouraging  results 
in  certain  developmental  disorders  and  irregularities  of 
metabolism  in  which  the  endocrine  organs,  and  especially 
the  pituitary  gland,  are  concerned. 

Since  the  paroxysms  of  asthma  are  frequently  controlled 
in  a  remarkable  manner  by  injections  of  adrenalin,  Warf  el 
wondered  if  there  might  not  be  a  definite  hypoadrenia  which 
could  be  modified  by  organotherapy.  He  proposed  to  do  this 
by  recourse  to  one  of  the  peculiar  phases  of  organotherapy 
— the  use  of  extracts  from  an  organ  or  organs  which  indi- 
rectly increase  the  physiologic  activities  of  a  hormone-pro- 
ducing organ  which  is  in  intimate  relation  to  the  organs 
from  which  the  extracts  are  made.  Incidentally  it  might  be 
remarked  that  adrenal  insufficiency  is  frequently  benefited 
by  certain  glandular  extracts  or  combinations  of  extracts 
other  than  adrenal  substance  itself. 

Warfel  selected  seven  cases  of  bronchial  asthma,  as  nearly 
typical  as  possible,  and  to  each  gave  21/£  grains  of  the  desic- 
cated anterior  lobe  substance  four  times  a  day.  His  article 
contains  a  report  of  each  of  these  cases,  and  the  conclusions 
drawn  seem  to  indicate  that  his  treatment  offers  much  en- 
couragement in  the  control  of  a  condition  which  is  not  easily 
influenced  by  other  therapeutic  procedures.  He  reports  that 
each  case  thus  treated  showed  a  marked  improvement  in 
the  prominent  symptoms  within  48  hours.  The  treatment 
was  continued  for  periods  ranging  from  ten  days  to  seven 


ORGANOTHERAPY  IN  ASTHMA  271 

weeks,  with  most  encouraging  results.  The  expectoration 
was  decreased,  a  circumstance  which  was  accompanied  by  a 
feeling  of  dryness  in  the  mouth  and  throat  which,  however, 
was  relieved  by  sipping  water.  The  distressing  dyspnea 
disappeared  entirely.  In  two  of  the  seven  cases  there  was  a 
considerable  trace  of  albumin  in  the  urine  which  disappeared 
after  the  treatment  had  been  continued  for  a  short  time. 
The  blood  pressure  did  not  seem  to  be  influenced  either  up 
or  down;  and  Warfel,  while  admitting  that  the  number  of 
cases  was  limited,  suggests  that  as  the  results  secured  in 
this  series  were  so  generally  favorable  and  constant,  further 
trials  of  this  procedure  are  desirable  in  other  similar  cases. 
Since  the  publication  of  his  first  report,  many  additional 
cases  of  bronchial  asthma  have  been  treated  as  outlined 
above,  with  good  results.  It  seems  to  be  a  measure  worth 
trying  still  further. 

The  Complexity  of  the  Asthmatic  Syndrome.  The  trouble 
with  the  problem  of  the  asthmatic  is  due  to  the  fact  that 
bronchial  asthma  is  a  very  complex  condition.  There  is  an 
undoubted  endocrine  factor  in  many  cases,  but  too  often 
there  is  a  bronchitis  with  absorption  of  the  products  of 
bacterial  growth  and  decomposition,  with  an  anaphylaxis- 
like  reaction  to  these  foreign  proteids.  Again,  similar  re- 
actions occurring  in  unusually  sensitive  persons  following 
the  absorption  of  protein  from  pollens  and  other  similar 
substances — hay  fever,  horse  asthma,  rose  colds  and  such 
like — are  a  few  of  the  manifestations  of  this  character 
which  complicate  matters.  The  majority  of  individuals 
suffering  from  bronchial  asthma  are  asthenic,  and  there 
are  not  a  few  references  in  the  literature  to  the  value 
of  adrenal  substance  in  cases  of  this  kind ;  it  might,  there- 
fore, properly  be  included  with  anterior  pituitary  substance 
in  an  antiasthmatic  pluriglandular  formula.  Based  upon 
these  scattered  notions,  a  number  of  experimental  formulas 
have  been  made  and  used  in  different  kinds  of  asthma  with 
varying  results.  In  fact,  in  some  instances,  the  results  were 
very  good,  while  in  a  number  of  others  they  are  quite 
negative. 

An  Organotherapeutic  Formula.  A  number  of  sugges- 
tions along  these  lines  have  been  carried  out  in  this  labora- 
tory, and  a  formula  (No.  26),  Adreno-Hypophysis  Co. 
(Harrower),  is  offered  for  use  in  the  various  phases  of 
asthma  in  which  the  effects  likely  to  be  secured  from  a 
formula  of  this  kind  possibly  might  be  of  adjuvant  value  in 
the  treatment. 


272  PRACTICAL  ORGANOTHERAPY 

There  are  several  suggestions  in  the  literature  that  cal- 
cium lactate  has  been  beneficial  in  certain  asthmatic  states, 
and  this  salt  is  therefore  used  in  the  excipient. 

Since  bronchial  asthma,  especially  in  elderly  persons,  is 
such  a  heart-breaking  condition  and  so  unresponsive  to  or- 
dinary treatment,  save  only  the  hypodermic  injections  which 
most  asthmatics  soon  come  to  dread,  it  really  seems  as 
though  experimental  glandular  feeding  should  be  more  rou- 
tinely suggested.  While  there  is  no  way  of  telling  in  ad- 
vance what  sort  of  a  result  may  be  secured,  it  may  be  stated 
definitely  that  the  administration  of  the  average  doses  of 
these  glands  is  without  harm,  and  on  an  entirely  different 
basis  from  the  continued  injections  of  the  adrenal  or  pitui- 
tary principles. 

The  administration  of  Adreno-Hypophysis  Co.  should  be 
carried  out  with  a  full  understanding  on  the  part  of  the  pa- 
tient that  it  may  or  may  not  be  of  service.  We  can  speak 
with  confidence  of  the  value  of  the  adrenal  support  obtained 
from  that  particular  ingredient,  and  this,  of  course,  is  worth 
while.  We  can  tell  what  others  have  said  and  of  results 
that  have  been  secured,  but  the  subject  is  being  dis- 
cussed here  with  some  diffidence  merely  because  there  is 
so  much  yet  to  be  learned.  The  dose  recommended  is  from 
three  to  six  doses  a  day,  and  obviously  every  effort  should 
be  made  simultaneously  either  to  control  any  infective  con- 
dition that  may  be  present  or  to  have  the  patient  keep  away 
from  foods  and  conditions  which  are  known  to  be  aggra- 
vating. A  reduction  of  the  amount  of  animal  proteids  that 
are  eaten  and  persistent  colon  hygiene  invariably  should  be 
recommended. 

I  want  it  understood  that  this  whole  proposition  is  purely 
experimental.  We  have  not  a  cure  for  asthma,  and  I  make 
no  pretentious  claims  to  any  special  knowledge  on  this  sub- 
ject. We  only  know  that  some  people  who  have  had  asthma 
for  years  and  "have  tried  everything  else",  are  now  free 
from  it. 

It  will  be  a  pleasure  to  cooperate  with  interested  physi- 
cians who  may  have  some  ideas  regarding  the  development 
of  our  present  knowledge  of  asthma  from  the  endocrine 
standpoint;  and  it  should  be  remembered  that  my  labora- 
tory was  established  for  the  express  purpose  of  broadening 
practical  clinical  information,  where  this  is  possible,  by 
making  a  given  idea  immediately  and  conveniently  utilizable 
by  those  who  choose  to  do  so. 


ORGANOTHERAPY  IN  NEURITIS  273 

SECTION  V.    CHAPTER  17 
ORGANOTHERAPY  IN  NEURITIS 


I  have  run  across  many  cases  labeled  neuritis  that  were 
nothing  more  or  less  than  irritability  of  certain  sensory 
nerves,  due  to  toxemia.  According  to  Borland,  neuritis  is 
"inflammation  of  a  nerve"  and  we  shall  now  proceed,  if  pos- 
sible, to  connect  this  condition  with  disturbed  endocrine 
function. 

Every  physician  knows  that  the  chief  cause  of  neuritis- 
is  toxemia.  It  may  be  bacterial,  and  often  is,  but  very  much 
more  often  it  is  due  to  the  absorption  of  poisons  either  from 
the  alimentary  canal,  or  from  foods  which  are  ingested 
wilfully  or  accidentally. 

Every  physician  also  knows  that  chronic  conditions  in 
which  the  chemistry  of  the  body  has  been  disturbed  by 
whatever  circumstances  may  be  involved,  are  very  com- 
monly associated  with  painful  disturbances  that  are  called 
neuritis.  They  may  not  be  technically  and  scientifically 
neuritis,  but  they  are  called  neuritis  and  the  point  is  that 
these  conditions  are  due  to  the  accumulation  of  unoxidized 
waste  products  which  cause  an  irritation  which  produces 
symptoms  exactly  similar  to  those  accompanying  a  real 
inflammation  of  the  nerve. 

The  Thyroid  Involvement.  One  of  the  commonest  causes 
of  deficient  cellular  chemistry  is  hypothyroidism.  Conse- 
quently, one  of  the  commonest  causes  of  neuritis  is  hypo- 
thyroidism. We  need  not  take  very  long  to  find  that  this 
is  the  case.  Myxedema,  the  most  decisive  form  of  full- 
blown hypothyroidism,  practically  always  is  associated  with 
neuritis,  and  other  painful  manifestations  due  to  the  cellular 
intoxication  and  infiltration  of  the  nerve  cells  and  their 
sheaths,  and  the  discomfort  is  very  real,  though,  fortu- 
nately, amenable  to  thyroid  therapy. 

One  does  not  have  to  look  for  so  serious  a  thyroid  insuffi- 
ciency as  myxedema  to  find  a  beginning  of  the  discomforts 
that  ordinarily  are  called  neuritis.  Many  an  individual 
whose  detoxicating  mechanism  has  been  overburdened,  sud- 
denly finds  that  an  arm,  or  shoulder,  or  calf,  or  some  par- 
ticular locality  of  the  body  is  very  painful  and  tender,  and 
perhaps  there  may  be  even  more  serious  manifestations  in 
the  nature  of  what  appear  to  be  a  paralysis  and  motor  diffi- 

1 8 


274  PRACTICAL  ORGANOTHERAPY 

culties.  At  all  events,  to  repeat,  hypothyroidism  is  very 
commonly  associated  with  neuritis  and,  therefore,  to  my 
way  of  thinking,  whenever  we  run  across  an  individual  who 
complains  of  neuritis,  one  of  the  things  in  our  further  in- 
vestigation of  these  cases  is  to  determine  whether  their 
physiological  chemistry  is  as  normal  as  it  should  be,  and, 
if  it  is  deficient,  whether  the  thyroid  possibly  is  at  fault. 

Advantage  of  Harrower's  Thyroid  Test.  I  have  treated 
many  scores  of  cases  with  neuritis :  some  of  them  with  no 
other  particular  symptomatology;  others  associated  with 
rheumatism,  or  anemia  and  the  general  run-down  condition 
so  common  in  chronic  disease,  and  these  cases  were  treated 
successfully  many  a  time  by  considering  that  they  were  suf- 
fering from  hypothyroidism.  In  many  cases  I  have  estab- 
lished my  suspicions  by  the  use  of  my  Thyroid  Function 
Test  and  then  have  changed  from  an  empirical  attitude  to 
SL  more  scientific  one;  however,  in  most  instances,  whether 
the  Thyroid  Function  Test  obviously  is  an  indicator  of  a 
hypothyroidism,  or  whether  I  merely  presume  that  hypo- 
thyroidism is  present,  I  begin  to  encourage  the  cellular 
chemistry,  increase  the  circulation  and  favor  in  this  man- 
ner a  return  to  a  more  normal  condition  with  the  result 
that  in  many  instances  the  neuritis  has  disappeared.  I  have 
cured  neuritis  too  often  with  organotherapy  to  listen  to  any 
who  deny  this. 

Adrenal  Depletion  is  Common.  There  is  another  aspect 
to  neuritis  that  deserves  equal  mention  and  consideration. 
All  of  the  individuals  in  the  class  we  have  been  discussing, 
are  of  the  type  that  is  often  called  "hypoadrenal."  The 
toxemia,  usually  of  long  standing,  has  overstimulated  the 
adrenal  glands  until  they  are  physiologically  depleted,  and 
in  conjunction  with  the  resulting  neuritis,  we  have  obvious 
evidence  that  nitrogenous  elimination  is  deficient — the  urea 
in  twenty-four  hours  is  much  below  normal,  sometimes  is 
0.9  per  cent,  or  less,  and  practically  always  is  one  half  of 
what  is  considered  to  be  an  average  normal  percentage  of  a 
twenty-four  hour  specimen.  There  are  plenty  of  evidences 
of  poor  circulation — the  skin  is  sometimes  bluish  and  mottled 
in  appearance,  the  extremities  are  cold,  the  heart  action 
is  often  weak  and  the  systolic  blood-pressure  many  times 
is  below  100  mm.  These  patients  are  just  as  tired  as  their 
chemistry  is  tired.  They  have  all  sorts  of  aches  and  pains— 
sometimes  they  are  cerebral  and  are  in  the  nature  of  a 
chronic  persistent  headache,  many  times  worse  in  the  morn- 
ings— and  a  neuritis  is  added  to  all  these  other  difficulties. 


ORGANOTHERAPY  IN  NEURITIS  275 

Bearing  these  things  in  mind,  might  we  not  say  that 
these  individuals  have  a  thyro-adrenal  insufficiency?  They 
do,  as  a  matter  of  fact,  for  many,  many  times  hypothyroid- 
ism  is  complicated  by  adrenal  insufficiency  and,  on  the  other 
hand,  the  opposite  is  equally  true.  These  two  endocrine 
glands  work  together.  They  regulate  the  detoxicating 
mechanisms  of  the  body.  They  are  believed  to  be  concerned 
in  the  control  of  immunity.  They  involve  those  factors 
which  stimulate  and  regulate  the  sympathetic  mechanism 
of  the  body.  They  assist  in  maintaining  the  tone  of  the 
muscles  and  also,  most  important  of  all,  they  arouse,  or  set 
in  motion,  the  chemical  mechanism  we  call  detoxication. 

A  Routine  Treatment  of  Neuritis.  Neuritis,  then,  is 
commonly  associated  with  thyro-adrenal  insufficiency  and 
an  organotherapy  directed  at  encouraging  the  thyroid  ac- 
tivity and  antagonizing  the  circumstances  resulting  from 
the  adrenal  insufficiency,  is  very  likely  to  modify  the  neu- 
ritis satisfactorily. 

Adrenal  support  is  a  tried-and-proved  measure  in  neu- 
ritis that  is  based  upon  a  physiological  derangement  of  the 
endocrine  organs  under  discussion.  It  is  directed  at  what 
is  often  the  real  underlying  cause,  and  failures  in  the  treat- 
ment of  neuritis  often  have  been  due  to  ignoring  this  cause. 
The  use  of  the  formula,  Adreno-Spermin  Co.  (Harrower) 
for  a  month  or  six  weeks,  coupled  with  a  purin-free  diet  and 
the  routine  elimination  and  local  measures  in  customary 
usage,  is  as  effective  a  routine  as  I  have  run  into. 

So  far  as  other  measures  are  concerned,  besides  every 
effort  to  reduce  toxemia  to  the  utmost,  I  have  found  that 
certain  foods  including  the  easily  putrefiable  proteids  and 
especially  certain  substances  to  which  individuals  are  un- 
usually sensitive  (food  allergy),  often  are  aggravating  fac- 
tors ;  this  aspect  should  be  taken  care  of  at  the  same  time. 

Focal  infection,  the  most  common  cause  of  adrenal  insuffi- 
ciency, and  the  syndrome  under  consideration,  should  be 
sought  for  most  carefully,  and  every  effort  made  to  remove 
it.  Many  a  neuritis  of  the  arm  is  based  upon  several  bad 
teeth.  Or  a  tonsillar  infection  may  occur  in  apparently  nor- 
mal tonsils,  in  which  the  crypts  only  are  infected,  and  in 
which  there  is  no  obvious  swelling  or  anatomical  change. 

A  common  basic  cause  which  must  not  be  overlooked  is 
alimentary  toxemia.  A  chronic  appendicitis  many  a  time 
has  been  the  real  cause  of  a  serious  neuritis.  Digestive 
apathy — both  secretory  and  muscular — and  intestinal  stasis 


276  PRACTICAL  ORGANOTHERAPY 

are,  perhaps,  even  more  important;  and  the  alimentary 
encouragement  offered  by  Secretin  Co.  (Harrower) — see 
Section  V,  Chapter  24 — has  often  indirectly  helped  a  bad 
neuritis. 

Remineralization.  With  this  line  of  treatment,  in  ad- 
dition to  the  use  of  measures  calculated  to  increase  alimen- 
tary elimination  thoroughly,  I  urge  remineralization  or  the 
antagonizing  of  the  accumulation  of  acid  wastes,  which  result 
from  the  disturbed  chemistry  just  referred  to.  These  pa- 
tients very  often  are  in  the  condition  of  systemic  acidity  or 
hypoalkalinity  which  may  be  as  much  at  the  bottom  of  neu- 
ritis as  any  other  factor.  They  are  starving  for  alkalies, 
and  their  slow  chemistry  favors  the  accumulation  all  the 
time  of  still  more  acid,  which  removes  from  the  body  its 
rightful  reserve  of  these  all-essential  mineral  salts.  The 
French  many  times  have  referred  to  the  importance  of  re- 
mineralization  in  conditions  of  neuritis,  and  one  of  the 
important  associate  measures  which  may  be  given  in  con- 
junction with  organotherapy,  is  this  remineralization,  or 
the  administration  of  certain  suitable  alkali  salts  in  the  ex- 
pectation of  adding  to  the  reserve  of  these  substances  and 
neutralizing  as  many  as  possible  of  the  accumulated  wastes 
as  well  as  those  which  are  being  produced  from  day  to  day 
in  greater  amounts  than  can  be  taken  care  of  routinely. . 

We  have  a  formula  called  Calcium-Phosphorus  Co.  (Har- 
rower) which  contains  magnesium  phosphate,  calcium 
phosphate,  calcium  glycerophosphate,  potassium  bicarbon- 
ate and  sodium  bicarbonate,  in  proportions  quite  similar  to 
those  in  which  we  find  the  various  salts  found  in  the  body. 
Five  or  six  grams  a  day  of  such  mixture  is  a  very  decided 
advantage  in  the  associate  treatment  of  neuritis.  (See 
chapter  on  "Remineralization,"  Section  V,  Chap.  25.) 

The  combination  of  organotherapy  mentioned  above  and 
remineralizing  treatment  should  be  recommended  for  at 
least  8  or  10  weeks.  The  usual  dosage  is  one  of  the  Adreno- 
Spermin  Co.  at  each  meal  and  at  bedtime,  plus  three  of  the 
Calcium-Phosphorus  Co.  tablets,  crushed,  with  much  water 
an  hour  before  food  twice  a  day  for  three  or  four  weeks 
and  thereafter  on  alternate  weeks.  This  makes  up  a  com- 
bined cell-stimulating  and  waste-neutralizing  routine  which 
has  had  to  do  with  the  cure  of  many  scores  of  cases. 

The  endocrine  side  of  the  treatment  of  the  various  forms 
of  neuritis  is  as  encouraging  a  one  as  I  know  of,  and  liter- 
ally scores  of  physicians  have  expressed  themselves  as  de- 
lighted at  the  application  of  the  foregoing  measures. 


RHEUMATISM  277 

SECTION  V.    CHAPTER  18 
INTERNAL  SECRETIONS  IN  RHEUMATISM 


In  June,  1915,  the  publishers  of  American  Medicine 
(New  York)  produced  a  very  comprehensive  and  credit- 
able special  issue  on  rheumatism.  The  editor  kindly 
invited  me  to  contribute  some  ideas  on  the  endocrine  aspects 
of  this  disease,  and  the  following  remarks,  modified  and 
brought  down  to  date,  are  passed  on  for  what  they  may 
be  worth  to  readers  of  this  book. 

Rheumatism  and  the  rheumatic  diathesis  are  conditions 
concerning  which  there  are  numerous  and  widely  differing 
views.  The  literature  regarding  the  various  phases  of 
rheumatism  is  as  extended  as  it  is  contradictory.  The  un- 
suspecting reader  frequently  is  led  into  a  morass  of  differ- 
ing conceptions  from  which  it  is  not  always  the  easiest 
thing  to  extricate  himself. 

Ideas  Regarding  the  Causes  of  Rheumatism.  Some  writ- 
ers insist  that  "rheumatism"' — and  by  that  they  usually 
include  the  varying  disorders  which  have  been  classed  under 
this  name — is  a  manifestation  of  digestive  trouble  pure  and 
simple;  correct  the  digestion  and  the  rheumatism  auto- 
matically will  be  taken  care  of. 

Others  insist  that  it  is  essentially  the  result  of  an  im- 
perfect mineral  metabolism  and  assure  the  reader  that 
recourse  to  certain  inorganic  neutralizing  measures  will 
quickly  bring  conviction  regarding  the  correctness  of  this 
view. 

Still  others  assert  that  there  is  a  bacterial  origin,  not  only 
for  the  obviously  infective  forms  of  rheumatism,  but  for 
all  of  them;  and  that  the  successful  treatment  of  this  dis- 
order is  not  complete  without  at  least  the  addition  of  pro- 
cedures based  upon  its  "undoubted  microbic  origin." 

Much  has  been  written  regarding  the  relation  of  uric  acid 
to  the  rheumatic  diathesis,  and  opinions  seem  to  be  veering 
away  from  the  statements  so  ably  presented  by  Haig,  of 
London.  In  a  communication  which  appeared  in  the  Inter- 
state Med.  Jour.,  April  1915,  Goodman,  of  St.  Louis,  aptly 
remarks  that :  "The  uric  acid  theory  is  at  present  tottering 
on  its  unstable  foundations  and  we  are  growing  more  and 
more  inclined  to  the  view  that  not  uric  acid,  but  rather  dis- 
turbances of  intermediary  purin  metabolism,  are  at  the 
root  of  the  evil." 


278  PRACTICAL  ORGANOTHERAPY 

The  Broader  Aspect.  Looking  at  this  problem  from  the 
standpoint  of  an  average  physician,  it  is  altogether  probable 
that  there  is  an  element  of  truth  in  all  of  the  theories  re- 
garding rheumatism  and  that  the  statements  which  serve 
as  a  prelude  to  this  article  are  all  correct  to  a  certain  degree. 
None  can  deny  that  rheumatism,  in  the  majority  of  instan- 
ces, exhibits  as  one  of  its  most  constant  manifestations  a 
disturbance  of  metabolism,  and  considerable  evidence  is 
accruing  to  indicate  that  not  a  few  of  these  cases  have  as 
the  original  basis  of  the  trouble  an  obscure  infective  pro- 
cess which  may  never  be  so  obvious  as  to  direct  attention 
to  itself,  but  is  only  brought  to  light  following  the  empiric 
use  of  stock  vaccines  given  with  the  expectation  that  this 
unnoticed  infection  may  be  present.  In  such  cases  (and 
Sherman,  of  Detroit,  has  frequently  directed  attention  to 
the  importance  of  this  class)  the  diagnosis  is  often  made 
by  the  clinical  results  of  the  empirical  treatment,  and  it  may 
be  stated  in  unqualified  terms  that  many  of  the  chronic 
rheumatic  affections  are  of  bacterial  origin,  even  though 
they  may  show  none  of  the  typical  findings  of  obviously 
infective  cases. 

An  Alimentary  Factor.  The  manifestations  of  the  rheu- 
matic diathesis  are  too  frequently  associated  with  digestive 
disturbances  for  the  consistent  physician  to  deny  the  inti- 
ma«y  of  this  relation,  and  it  is  not  an  uncommon  thing  for 
dietetic  regulation,  with  attention  to  the  inevitable  defective 
elimination  resulting  from  digestive  activity,  to  bring  about 
complete  control  of  the  rheumatic  phenomena.  Certain  it 
is  that  the  excessive  amounts  of  proteid  which  are  so  com- 
monly eaten  combine  with  other  factors  to  bring  about  the 
metabolic  chaos  which  is  so  usually  called  rheumatism. 
Parenthetically,  it  might  be  remarked,  these  persons  are  not 
suffering  from  the  results  of  mineral  excess,  although  the 
laboratory  evidence  may  seem  to  indicate  this ;  rather  they 
are  undergoing  their  tortures  because  of  a  lack  of  the  nat- 
ural mineral  elements — the  vegetable  alkalies — which  the 
body  needs,  and  which  they  could  just  as  well  have  if  their 
diet  included  more  of  such  articles  as  potatoes,  greens  and 
cereals,  and  less  meat. 

Whether  or  not  the  initial  cause  is  dietetic  or  bacterial  in 
origin  there  can  be  no  doubt  that  all  forms  of  rheumatism 
are  evidences  of  essential  changes  in  the  chemistry  of  the 
body,  and,  this  being  granted,  should  not  the  regulators  of 
metabolism  be  considered  both  in  the  etiology  as  well  as 
in  the  treatment  of  the  various  forms  of  this  disorder? 


RHEUMATISM  279 

The  Internal  Secretions  in  Rheumatism.  It  should  be 
quite  unnecessary  to  lend  emphasis  to  the  importance  of 
the  glands  of  internal  secretion  as  regulators  of  the  func- 
tions of  the  body.  The  hormones  not  only  control,  but 
correlate  these  various  cell  activities,  and  their  work  is  so 
closely  connected  with  the  factors  which  are  concerned  in 
the  reaction  of  the  body  to  the  causes  of  rheumatism,  as 
well  as  to  the  attempts  made  to  remedy  this  condition,  that 
the  physician  who  considers  the  relation  of  the  internal  se- 
cretory glands  and  their  hormones  to  rheumatism  is  more 
likely  to  solve  some  of  its  mysteries  than  the  one  who  over- 
looks them  entirely. 

It  is  remarkable  how  close  a  relationship  may  be  dis- 
covered between  certain  of  the  ductless  glands  and  the 
symptoms  which  have  come  to  be  considered  pathognomonic 
of  rheumatism.  Presuming  for  a  moment  that  the  various 
manifestations  of  the  rheumatic  diathesis  are  toxic  in  ori- 
gin, is  not  detoxication  essentially  controlled  by  certain  of 
the  endocrine  glands? 

If  the  infective  origin  of  rheumatism  is  admitted  to  be 
the  most  frequent  or  important,  then  we  must  also  admit 
that  certain  of  these  remarkable  organs  are  responsible  for 
the  production  of  the  protective  measures  which  the  body 
automatically  bring  into  play  in  infections.  Sir  Almroth 
Wright  himself  insists  that  all  the  substances  concerned 
in  the  control  of  infections  must  be  considered  as  products 
of  the  internal  secretory  organs. 

If  functional  digestive  disturbances  are  the  most  com- 
mon basis  for  this  condition,  then  it  is  proper  to  consider 
the  relation  of  the  alimentary  hormone,  secretin,  to  this 
disease  and,  where  digestive  insufficiencies  are  manifestly 
present,  have  recourse  to  the  use  of  secretin  as  a  remedy,  for 
I  am  thoroughly  convinced  of  its  value  as  a  physiologic 
means  of  stimulating  lazy  or  inactive  digestive  glands.  So 
whether  rheumatic  conditions  are  purely  metabolic  in  origin, 
or  whether  they  are  due  to  microorganisms,  or  to  indiges- 
tion, we  must  not  belittle  the  fact  that  in  any  event  there 
must  be  a  role  that  the  internal  secretory  organs  play  which 
favors  their  prevention  as  well  as  the  cure.  The  clinical  use 
of  an  alimentary  stimulant,  such  as  Secretin  Co.  (Har- 
rower) ,  in  suitable  cases,  so  modifies  the  digestive  toxemia 
that  an  immediate  change  in  the  rheumatic  manifestations 
is  often  noticed. 

Under  the  present  circumstances  it  would  be  quite  diffi- 
cult to  consider  this  from  the  protective  or  prophylactic 


280  PRACTICAL  ORGANOTHERAPY 

standpoint.  Rheumatism  is  too  insidious  a  disease.  Its 
onset  is  of  such  a  nature  that  it  is  not  appreciated  until  one 
or  more  of  the  more  definite  manifestations — joint  pain, 
immobility,  swelling,  etc. — brings  the  patient  to  his  phy- 
sician. We  can,  however,  make  good  use  of  this  information 
in  the  diagnosis  and  treatment  of  rheumatic  conditions. 
For  example,  too  often  the  orthodox  treatment  with  salicy- 
lates  or  other  neutralizing  agents,  does  not  give  the  desired 
degree  of  results,  or  merely  tides  the  patient  over  whilst 
the  disturbed  chemical  conditions  are  under  the  influence 
of  the  drugs  or  measures  used.  After  a  longer  or  shorter 
time  the  patient  has  a  recurrence  and  unfortunately  too 
often  it  is  more  severe  than  the  initial  attack.  In  such 
cases  the  knowledge  that  the  ductless  glands  may  be  fre- 
quently concerned  in  rheumatism  will  enable  the  physician 
to  consider  the  case  from  a  slightly  different  angle — one 
which  I  regret  to  say  is  rarely  taken  by  the  medical  pro- 
fession— and  this  new  viewpoint  may  facilitate  the  control 
of  future  manifestations.  It  will  also  open  up  the  possibil- 
ities of  certain  forms  of  organotherapy  which,  rightly 
applied,  may  materially  influence  the  response  of  the  organ- 
ism to  the  other  usual  therapeutic  procedures.  Right  here 
it  should  be  emphasized  that  organotherapy  is  not  recom- 
mended as  the  sine  qua  non  in  the  treatment  of  rheumatic 
affections.  Far  be  it  from  such,  but  as  an  important  adju- 
vant and  a  phase  worthy  of  consideration  it  deserves  con- 
siderably more  attention  than  it  has  previously  received,  as 
may  shortly  appear. 

The  Importance  of  the  Thyroid.  Leopold  Levi,  of  Paris, 
insists  that  the  thyroid  is  quite  intimately  connected  with 
both  the  cause  and,  in  certain  cases,  the  successful  treat- 
ment of  various  joint  conditions,  not  excluding  the  most 
serious  form,  arthritis  deformans,  and  in  the  introduction  to 
his  little  book  (La  Petite  Insuffisance  Thyroi'dienne  et  son 
Traitement")  he  makes  the  following  statement:  "Thera- 
peutics is  invaluable  in  the  study  of  minor  thyroid  insuffi- 
ciency. It  has  revealed  to  us  a  certain  number  of  stigmata 
of  hypothyroidism  (which  might  otherwise  be  overlooked). 
In  March,  1905,  we  had  applied  thyroid  treatment,  for  the 
first  time,  aside  from  myxedema,  on  a  patient  affected  with 
chronic  rheumatism  accompanied  by  psoriasis.  The  pri- 
mary effect  produced  by  the  medication  was  in  the  nature 
of  the  increased  appetite.  The  patient  when  first  questioned 
as  to  the  effect  of  the  feeding  with  the  thyroid  gland,  said: 


RHEUMATISM  281 

'It  makes  me  ravenous.'  Subsequently  his  appetite  was  so 
abnormal  that  those  in  attendance  on  the  patient  thought 
he  had  tenia.  A  second  result  following  the  medication  was 
a  marked  decrease  in  the  chilliness  which  he  had  been  ex- 
periencing. The  patient  had  been  chilly  to  an  amazing 
degree,  and  in  the  room,  which  he  occupied,  was  able  to 
stand  a  temperature  of  73  degrees  Fahr.,  living,  moreover, 
as  if  rolled  up  in  a  glass  screen.  The  effect  of  the  thyroido- 
therapy  was  such  that  he  was  not  so  fearful  of  the  cold. 
Soon  he  said  he  no  longer  needed  the  screen.  At  night  he 
had  less  clothes  on  the  bed,  and  whereas,  he  formerly  called 
for  several  blankets  and  an  eiderdown  on  his  bed,  he  was 
now  satisfied  with  one  light  blanket.  Thus  the  result  of 
thyroid  treatment  on  this  first  patient  was  such  as  to  di- 
rect attention  to  the  influence  exerted  by  the  thyroid  gland 
on  the  appetite  mechanism,  as  also  on  the  sensation  of  chilli- 
ness. The  application  of  thyroidotherapy  to  other  cases  of 
chronic  rheumatism  enabled  us  to  recognize  the  effect  of 
thyroid  treatment  of  constipation." 

Elsewhere  in  the  same  book  the  author  connects  thyroid 
disturbances  with  rheumatic  manifestations  and  quotes  a 
large  number  of  reports  to  the  effect  that  "the  reality  of 
the  thyroid  causes  of  chronic  rheumatism  is  incontestable. 
its  existence  depends  in  many  cases  on  thyroid  lesions." 

Chronic  rheumatism  is  quite  common  in  subjects  present- 
ing signs  of  hypothyroidism  and  it  is  well  known  that  rheu- 
matic manifestations  may  be  associated  with  or  aggravated 
by  incidents  in  the  menopause.  Frequently  rheumatic  mani- 
festations follow  thyroid  atrophy  due  to  pathological  condi- 
tions or  following  thyroidectomy  for  Graves'  disease,  but 
the  most  important  proof  is  the  fact  that  the  use  of  thyroid 
extract  in  many  cases  ameliorates  rheumatic  manifesta- 
tions. 

Thyroid  Therapy  may  be  applied  frequently  in  the  treat- 
ment of  various  forms  of  arthritis  with  good  results.  There 
are  a  number  of  papers  recording  and  attempting  to  explain 
its  remarkable  results  in  various  forms  of  chronic  rheu- 
matism. Probably  the  most  comprehensive  of  all  these 
communications  is  that  of  Leopold  Levi  who  reports  three 
hundred  cases  treated  under  his  direction  during  a  period 
of  eight  years.  This  investigator,  who  is  well  known  to 
those  who  have  read  the  literature  on  the  thyroid  gland, 
differentiates  a  form  of  rheumatism  which  is  due  to  what 
he  terms  thyroid  instability.  The  disease  is  found  in  relat- 


282  PRACTICAL  ORGANOTHERAPY 

ively  young  persons,  is  only  slightly  deforming,  and  usually 
affects  the  smaller  joints.  It  seems  to  progress  by  fits  and 
starts.  In  these  cases  the  joint  disturbances  are  by  no 
means  the  only  troubles.  Occasionally  there  are  other  mani- 
festations of  functional  thyroid  disorder,  sometimes  evi- 
dently due  to  increased  thyroid  activity  and  at  other  times, 
the  majority  of  cases  it  may  be  noted,  the  result  of  de- 
creased thyroid  activity. 

The  manner  in  which  this  form  of  rheumatism  responds 
to  treatment,  varies  considerably  with  the  associated  mani- 
festations. In  the  juvenile  form,  where  there  is  no  very 
serious  deformity,  the  response  to  treatment  is  good,  and 
while  the  serious  chronic  and  so-called  "incurable"  cases 
do  not  respond  as  rapidly  to  this  treatment,  there  is  no 
doubt  that  persistent  thyroid  therapy  causes  a  very  decided 
benefit  even  in  them.  Levi  concludes  that  in  many  cases  of 
chronic  rheumatism  thyroid  extract  is  "a  valuable  remedy," 
securing  an  average  of  results  that  is  very  encouraging, 
and  occasionally  producing  astonishing  changes  for  the  bet- 
ter. According  to  this  writer:  "Thyroid  therapy  should  be 
placed  in  the  first  rank  of  the  therapeutic  armamentarium 
in  the  treatment  of  chronic  rheumatism."  He  recommends 
a  daily  amount  ranging  from  .05  to  .30  grammes  (1  to  5 
grains)  in  divided  dosage.  The  average  is  IVfc  grains  a  day 
and  it  must  be  continued  for  as  long  as  six  months. 

The  Philosophy  of  Thyroid  Therapy.  The  mechanism  of 
the  action  of  thyroid  extract  in  certain  conditions  has  for 
some  time  been  in  doubt;  and  this  is  especially  true  as  far 
as  its  influence  in  rheumatism  has  been  concerned.  This 
extract,  above  all  others,  has  been  considered  one  of  the 
best  means  of  enhancing  cell  activities  and  increasing  the 
metabolic  exchanges.  Since  the  metabolism  in  rheumatism 
is  much  below  par,  any  advantage  that  accrues  from  thy- 
roid therapy  might  be  considered  as  due  to  this  salutary 
influence  upon  the  cells.  A  scientific  explanation  of  this 
may  be  gathered  from  some  interesting  experiments  by 
Slosse,  who  was  professor  of  physiology  at  the  University 
of  Brussels  before  the  war.  He  has  carried  out  a  number  of 
experiments  both  in  the  laboratory  and  in  the  clinic  to  con- 
nect the  disturbances  of  nitrogenous  metabolism  with  the 
work  of  the  ductless  glands,  and  as  a  result  of  his  investi- 
gations he  states  that  under  normal  circumstances  the  thy- 
roid gland  secretes  a  "hormone  de  desaminization" — a  de- 
aminizing  hormone — which  influences  the  nitrogenous  ex- 


RHEUMATISM  283 

changes  and,  when  deficient,  causes  a  reduction  of  the  power 
of  the  cells  throughout  the  whole  organism  to  split  up  the 
albuminoid  substances,  especially  the  nucleo-albuminoids, 
from  which  uric  acid  and  other  substances  of  the  purin 
group  are  formed.  Theoretically  then,  the  enhancement  of 
thyroid  action  should  favor  nitrogenous  metabolism,  and  a 
large  series  of  urinalyses  made  by  Slosse  and  his  associates 
substantiates  this.  The  favorable  clinical  experiences  which 
have  been  recorded  by  a  number  of  French  writers  in  a 
measure  may  be  explained  by  these  findings. 

An  Effective  Routine  in  Rheumatism.  In  view  of  the 
reasonableness  of  the  attitude  of  the  investigators  whose 
work  has  just  been  quoted,  there  should  be  no  doubt  that 
the  study  of  the  thyroid  aspect  of  rheumatism  is  well  worth 
while.  The  use  of  my  Thyroid  Function  Test  in  a  number 
of  cases  has  uncovered  a  real  thyroid  insufficiency,  which 
previously  had  been  overlooked,  and  with  the  information 
derived  from  this  test  in  hand,  there  can  be  no  guess-work 
about  the  application  of  thyroid  therapy  in  the  individual. 

Since  so  many  rheumatic  individuals  are  not  merely  in  a 
state  of  hypothyroidism,  but  in  a  general  state  of  hypo- 
crinism,  i.  e.,  there  seems  to  be  a  general  insufficiency  of  the 
ductless  glandular  activity  as  a  whole,  it  is  very  proper  to 
give  some  consideration  to  intimately  associated  glands  as 
well  as  the  thyroid,  and  this  has  been  found  to  be  very  satis- 
factorily accomplished  by  applying  concurrently  with  thy- 
roid therapy  the  principle  of  adrenal  support  which  has 
already  been  discussed  quite  fully.  It  will  be  found  that 
many  individuals  with  rheumatism  are  not  merely  subnor- 
mal from  a  chemical  standpoint,  but  their  circulation  is 
poor,  their  blood  pressure  is  very  often  much  lower  than 
normal,  and  too,  they  are  very  easily  fatigued.  In  other 
words,  they  are  suffering  from  a  deficient  burning  up  of 
the  wastes  of  their  own  physiology,  or  chemasthenia,  as  I 
have  termed  it.  To  take  care  of  this,  as  well  as  the  thyroid 
side  that  has  already  been  referred  to,  I  have  found  con- 
siderable advantage  from  the  use  of  Adreno-Spermin  Co. 
(Harrower)  which,  as  is  known,  is  a  combination  of  a  small 
dose  of  thyroid  with  a  suitable  dose  of  adrenal  substance 
and  spermin  from  the  interstitial  cells  of  Leydig.  The  rea- 
sons for  the  first  need  not  be  mentioned  again ;  the  adrenal 
substance  is  given  for  its  circulation-stimulating  effect  and 
for  its  influence  upon  the  general  tone  of  the  body,  whereas 
the  spermin,  in  addition  to  being  a  synergist  to  adrenal 


284  PRACTICAL  ORGANOTHERAPY 

therapy,  has  a  decided  dynamogenic  and  musculotonic  ef- 
fect, which  is  always  advisable  in  these  cases.  The  Adreno- 
Spermin  Co.  is  given  in  fairly  generous  dosage  over  a  per- 
iod of  at  least  two  months;  longer  if  possible.  Perhaps,  at 
the  beginning,  one  five-grain  dose,  three  times  a  day,  may 
be  given  for  two  weeks,  after  which  one  four  times  a  day 
for  another  two  weeks ;  thereafter  two  three  times  a  day. 

Acidosis  in  Rheumatism.  Bearing  in  mind  the  tendency 
to  acidosis  so  common  in  rheumatic  patients,  and  the  fact 
that  the  consensus  of  clinical  opinion  emphasizes  the  im- 
portance of  alkalinization,  not  merely  in  rheumatism,  but  in 
all  conditions  of  reduced  cellular  activity,  the  principle  of 
remineralization,  which  is  given  full  consideration  in  an- 
other chapter,  certainly  is  an  advantage  in  conjunction  with 
the  organotherapy  just  outlined.  The  use  of  the  remineral- 
izing  formula,  Calcium  Phosphorus  Co.  (Harrower),  in 
doses  of  three  grams,  powdered  and  taken  with  a  generous 
drink  of  water,  an  hour  before  food,  twice  a  day  for  a 
month  and  thereafter  on  alternate  weeks,  will  supplement 
very  materially  the  changes  which  we  hope  to  make  in  the 
chemistry  as  a  result  of  the  recommended  organotherapy, 
and  in  many  instances  the  combination  of  these  two  form- 
ulas has  made  a  remarkable  difference  in  the  rheumatism 
and  its  various  manifestations. 

Ovarian  Form  of  Rheumatism.  The  ovarian  form  of 
rheumatism,  if  we  may  classify  it  as  such,  is  another  of  the 
chronic  phases  of  that  malady  and  is  often  found  in  those 
who  have  a  serious  dysovarism,  especially  in  women  at  or 
following  the  menopause.  Clinically,  this  seems  to  empha- 
size the  opinion  that  the  ovarian  principle  has  something 
to  do  with  the  maintenance  of  the  body  chemistry,  and  the 
removal  of  this  factor,  either  by  surgery,  or  by  the  usual 
change  of  life,  favors  the  conditions  which  cause  the  rheu- 
matism. This  condition  is  likewise  of  endocrine  origin,  but 
instead  of  being  due  to  thyroid  insufficiencies,  it  is  a  result 
of  ovarian  insufficiency.  It  is  quite  possible,  too,  that  its 
etiology  is  partly  due  to  thyroid  disturbances.  At  least  it 
reacts  more  quickly  to  luteal  therapy,  especially  if  this 
procedure  is  applied  early  in  the  course  of  the  disease.  In 
this  connection,  Dalche's  statement  will  be  recalled,  that  the 
administration  of  ovarian  substance  has  given  very  good  re- 
sults in  instances  similar  to  the  above,  and  in  suitable  cases 
he  occasionally  combines  thyroid  and  luteal  substance. 

I  have  had  a  number  of  very  satisfactory  experiences 


RHEUMATISM  285 

from  the  combination  of  thyroid,  for  the  reasons  previously 
mentioned,  and  ovarian  substance  and  corpus  luteum,  to 
take  care  of  the  ovarian  aspects  of  the  case.  In  other  words, 
Thyro-Ovarian  Co.  (Harrower)  has  been  given  to  women 
with  a  menopausal,  rheumatic  manifestation,  with  good  re- 
sults; and  in  some  cases  in  individuals  who  have  been 
treated  previously  for  long  periods  without  any  permanent 
change  in  the  rheumatism.  The  fundamental  principle  of 
taking  care  of  all  the  various  associated  disturbances  is 
another  explanation  for  the  advantage  of  this  idea. 

It  is  difficult  definitely  to  state  which  case  of  rheuma^ 
tism  is  of  thyroid  origin  and  which  is  not.  According  to 
Leopold  Levi  and  de  Rothschild,  the  only  way  to  answer 
this  question  is  empirically  to  apply  thyroid  extract,  and 
in  explanation  of  this,  they  may  be  quoted  as  follows :  "From 
the  practical  point  of  view,  in  all  forms  of  rheumatism  in 
which  the  cause  is  unknown,  it  is  an  advantage  to  apply 
thyroid  therapy.  In  such  cases  there  will  be  more  chance  of 
results  if  the  subject  is  young,  if  the  rheumatism  is  accom- 
panied by  subacute  exacerbations,  and  if  there  is  only 
slight  deformity.  In  those  cases  where  there  is  a  decided 
thyroid  influence  the  initial  results  will  be  rapid,  some- 
times immediate.  If  the  treatment  does  not  act  immediately, 
it  is  advisable  to  vary  the  doses,  sometimes  reducing  them 
and  giving  the  remedy  for  a  longer  period.  There  is  no 
doubt  that  this  medication  may  render  very  great  service 
in  the  treatment  of  certain  rheumatics,  without  exposing 
them  to  the  least  danger."  Of  course  Leopold  Levi  looks 
at  every  disease  from  the  standpoint  of  its  relation  to  the 
thyroid  gland — he  has  been  called  "thyroid  mad" — but  the 
fact  remains  that  he  and  his  associate,  Baron  Henri  de 
Rothschild,  are  successfully  treating  scores  of  cases  at  their 
hospital  with  thyroid. 

Thymus  in  Arthritis  Deformans.  The  thymus  is  another 
gland  which  seems  to  be  connected  in  some  way  with  the 
joint  manifestations  of  rheumatism,  and  several  references 
have  appeared  in  the  literature  in  the  last  few  years  extoll- 
ing the  value  of  thymus  extract  in  these  chronic  joint  con- 
ditions. 

Naturally,  it  is  far  from  possible  always  to  cure  the  dis- 
ease, but  according  to  Nathan,  of  New  York  City,  the  first 
and  most  important  beneficial  change  due  to  the  thymus 
medication  is  a  reduction  in  the  pain  present,  and  later, 
provided  the  case  responds  to  the  treatment,  there  is  an 


286  PRACTICAL  ORGANOTHERAPY 

increased  mobility  as  well  as  general  betterment  of  the  nu- 
trition and  health. 

It  is  not  yet  possible  to  explain  why  thymus  medication 
does  this  and  in  what  mysterious  manner  these  results  are 
brought  about,  but  we  know,  at  least,  that  in  early  life  the 
thymus  controls  in  a  considerable  degree  the  mineral  metab- 
olism, for  it  will  be  recalled  that  thymectomy  causes  a 
remarkable  softening  of  the  bones  and  an  obvious  disturb- 
ance of  mineral  metabolism.  It  may  be  therefore,  that  there 
is  a  principle  in  thymus  extract  which  favors  the  reestab- 
lishment  of  the  disordered  metabolism  of  calcium  salts, 
which  is  undoubtedly  a  factor  in  these  rheumatic  cases, 
and  that  the  benefit  is  due  solely  to  this.  Suffice  it  to  say 
that  in  the  treatment  of  arthritis  def ormans  Nathan  recom- 
mends 15  or  more  grains  of  thymus  substance  three  times 
a  day  given  for  weeks  or  months  and  that  some  very  en- 
couraging results  have  been  reported. 

A  Pluriglandular  Formula.  Early  in  the  work  of  this 
laboratory  I  was  importuned  to  make  a  combination  of 
Adreno-Spermin  Co.,  previously  mentioned,  and  thymus 
substance,  which  had  been  done  some  years  before  by 
Nathan.  For  some  time  a  preparation  known  as  Thymus- 
Spermin  Co.  (Harrower) — No.  57  on  our  list — was  pre- 
pared as  a  special  formula  for  the  few  physicians  who  chose 
to  use  it.  I  was  never  very  enthusiastic  about  it.  In  Feb- 
ruary, 1920,  I  published  in  The  Organotherapeutic  Review, 
a  brief  item  from  a  more  recent  paper  by  Nathan  ("An  Ex- 
perimental and  Clinical  Study  of  Arthritis  Deformans  as 
an  Infectious  Disease,"  Jour.  Medical  Research,  May,  1917) , 
in  which  appeared  the  following  sentence :  "I  can  only  say 
a  few  words  as  regards  the  treatment  of  this  condition. 
Some  years  ago  I  strongly  advocated  the  use  of  thymus 
extract  in  the  treatment  of  these  diseases.  At  that  time  I 
stated  that  this  substance  is  not  a  specific,  and,  from  what 
has  been  said  in  the  foregoing  pages,  there  can,  of  course, 
be  no  doubt  in  regard  to  this.  The  fact  nevertheless  re- 
mains that  thymus  seems  to  have  a  very  definite  beneficial 
eflcect  upon  the  nutrition,  and  I  still  find  that  in  those  cases 
in  which  the  joints  are  not  destroyed  or  ankylosed  (pro- 
vided it  is  long  continued  and  the  routine  dieting  and 
mechanical  treatment  which  are  so  harmful  are  omitted) 
it  nearly  always  leads  to  more  or  less  complete  recovery.'9 

In  my  comments  upon  this  quotation  I  said,  "This  method 
of  treatment  fails  very  often,  I  am  sorry  to  say.  For  two 


RHEUMATISM  287 

reasons:  (1)  Arthritis  deformans  usually  involves  too 
great  an  organic  or  structural  change  in  the  bones  and 
joints,  and  (2)  also  because  the  treatment  is  not  given  with 
sufficient  persistence."  Another  factor  worthy  of  mention 
in  this  connection  concerns  the  generally  reduced  oxidation 
and  elimination  in  these  cases ;  and  here  my  pluriglandular 
formula  Adreno-Spermin  Co.,  theoretically,  should  be  of 
considerable  value.  For  the  convenience  of  several  friends 
I  have  combined  equal  parts  of  this  formula  with  an  active 
preparation  of  thymus  gland,  and  this  should  be  given  in 
amount  of  four  to  eight  6-grain  doses  a  day  for  some  time 
as  an  adjuvant  to  other  accepted  treatment  in  chronic 
arthritis  deformans. 

I  have  had  a  number  of  encouraging  reports  and  pre- 
sume that  there  are  just  as  many  discouraging  ones  which 
have  not  come  to  me. 

I  remember  at  a  lecture  in  Chicago  that  I  had  been  asked 
for  my  opinion  of  the  possibilities  of  organotherapy  in 
chronic  rheumatism  and  arthritis  deformans  and  gave  a 
very  noncommittal  reply.  A  gentleman  got  up  and  asked 
for  the  privilege  of  making  some  remarks  and  said  that 
at  that  very  moment  he  had  on  his  list  no  less  than  seven 
persons  with  varying  degrees  of  rheumatism,  ranging  from 
a  chronic  rheumatism  to  a  serious  rheumatoid  arthritis,  all 
of  whom  had  been  given  Thymus-Spermin  Co.  (Harrower) 
in  periods  ranging  from  a  month  to  six  months,  and  all  of 
whom  had  been  very  decidedly  benefited  by  the  treatment. 
A  number  of  other  reports,  both  verbal  and  by  letter,  have 
confirmed  this  impression,  but  I  cannot  but  have  some 
qualms  in  urging  the  use  of  this  formula  merely  because 
in  too  many  of  the  cases  conditions  have  advanced  to  a 
point  where  no  results  can  be  expected.  If  the  physician  and 
the  patient  are  convinced  that  there  is  practically  no  hope 
from  other  therapy,  and  they  feel  justified  in  giving  this  a 
trial,  they  will  have  done  exactly  as  a  good  many  others 
have  done,  and  in  a  proportion  of  the  cases,  even  though 
it  may  not  be  so  very  large,  some  encouragement  may  be 
expected. 

In  conclusion,  let  us  remember  the  intimate  relation  of 
the  ductless  glands  to  metabolism,  the  undoubted  connec- 
tion between  rheumatism  and  metabolic  disturbances  and, 
therefore,  the  possibilities  of  organotherapy  as  a  meritori- 
ous adjunct  in  the  treatment  of  certain  forms  of  rheuma- 
tism. 


288  PRACTICAL  ORGANOTHERAPY 

SECTION  V.    CHAPTER  19 
THE  ENDOCRINES  IN  DERMATOLOGY 


The  principal  manifestation  of  disturbance  of  the  chief 
endocrine  gland — the  thyroid — is  a  change  in  the  skin. 
Myxedema,  as  its  name  implies,  is  referable  to  a  derma- 
tosis,  even  though  its  influence  upon  the  body  extends  very 
much  deeper.  In  a  paper  entitled  "The  Ductless  Glands 
and  Dermatology,"  Cunningham  of  New  York  (N.  Y.  Med. 
Jour.,  Jan.  19,  1918)  has  well  said:  "The  internal  secre- 
tions dominate  the  vital  functions.  Distressing,  disabling, 
and  even  fatal  consequences  follow,  in  the  general  economy, 
interference  with  their  normal  operation.  Is  it  a  far  cry 
from  this  to  the  inclusion  within  the  scope  of  their  perverted 
activities  of  the  many  mysterious  maladies  that  assail  the 
skin?  The  greater  includes  the  less.  The  envelope  of  the 
body  cannot  escape  the  deterioration  of  the  whole." 

The  thyroid  evidently  exerts  a  definite  influence  upon  the 
nutrition  of  the  skin,  for  hypothyroidism  has  among  its 
symptoms  many  disturbances  of  the  skin  and  its  appen- 
dages. In  addition  to  a  direct  relationship  between  the 
function  of  the  thyroid  and  the  skin,  there  is  an  equally 
important  indirect  relationship.  For  example,  it  is  well 
known  that  the  thyroid  presides  over  the  metabolism  of  the 
body  and  is  an  important  part  of  the  detoxicating  mechan- 
ism. If,  then,  there  is  a  deficiency  in  the  function  of  the 
thyroid,  naturally  there  will  be  a  change  in  the  body's 
powers  of  burning  up  wastes,  and  since  a  part  of  the  duty 
of  the  skin  is  to  facilitate  the  elimination  of  certain  wastes 
it  is  not  unreasonable  to  connect  certain  dermatoses  with 
the  deranged  chemistry  of  thyroid  origin ! 

It  seems  that  the  first  effort  to  apply  thyroid  therapy  in 
serious  dermatoses  was  that  of  Byrom  Bramwell,  of  Edin- 
burgh, who  in  1893  recommended  the  advantages  of  thyroid 
feeding  in  psoriasis,  scleroderma,  and  other  systemic  skin 
disturbances.  Much  of  the  good  that  was  reported  so  long 
ago  was  discounted,  and,  as  MacCleod  has  it,  (Practitioner, 
Feb.,  1915,  p.  298)  "its  further  use  led  to  frequent  disap- 
pointments and,  like  the  proverbial  rocket  stick,  it  came 
down  from  being  regarded  as  a  panacea  for  all  manner  of 
scaly  dermatoses  to  being  almost  entirely  neglected." 

This  is  exactly  what  has  happened  to  other  phases  of 


ENDOCRINES  IN  DERMATOLOGY  289 

organotherapy,  and,  as  I  have  repeatedly  shown,  much  of 
this  reaction  was  due  to  ignorance  and  especially  to  a  failure 
to  consider  the  relations  of  these  glands. 

The  Thyroid  Manifestations.  In  a  fairly  extensive  litera- 
ture there  is  found  evidence  that  the  discovery  of  hypothy- 
roidism,  and  its  treatment  with  suitable  thyroid  therapy, 
has  changed  the  character  of  the  skin  as  by  a  miracle.  Pre- 
viously it  had  been  rough,  scaly,  and  cold  to  the  touch, 
with  falling  hair,  cracking  nails  and  a  marked  degree  of 
"skin  inactivity."  And  not  merely  was  the  appearance  of  the 
skin  changed  but  so  were  its  circulation  and  functional  use- 
fulness. It  is  quite  interesting  to  contrast  the  dry,  rough, 
harsh,  cold,  inactive  skin  of  hypothyroidism  with  the  moist, 
thin,  easily  flushed  and  hyperactive  skin  of  hyperthyroid- 
ism. 

Among  nutritional  or  systemic  dermatoses  associated 
with  the  infiltration  of  hypothyroidism  (see  especially  Sec- 
tion IV,  Chapter  3)  are  psoriasis — already  mentioned  as 
having  been  among  the  first  dermatoses  to  be  treated  with 
organotherapy — ichthyosis,  xeroderma,  scleroderma,  pit- 
yriasis,  and  certain  forms  of  eczema. 

Psoriasis.  I  have  seen  considerable  benefit  follow  the 
use  of  suitable  organotherapy  in  psoriasis  despite  the  un- 
responsiveness  of  this  particular  dermatosis  to  any  form 
of  therapy.  I  confess  that  my  attitude  to  the  use  of  glandu- 
lar remedies  always  has  been  to  consider  them  as  adjunct 
measures,  and  whenever  I  have  been  asked  for  my  opinion 
of  the  value  of  a  remedy  I  have  urged  its  use  in  conjunc- 
tion with  suitable  eliminative,  dietetic  and  medicinal  meas- 
ures. Some  of  my  well-meaning  friends  have  immediately 
said  that  the  good  from  the  treatment  might  as  well  have 
been  due  to  the  associate  treatment  as  to  the  organotherapy 
—and  I  admit  it  very  frankly — but  it  is  perhaps,  more  than 
a  coincidence  that  some  of  these  patients  had  been  taking 
their  treatment  for  10,  15  or  20  years  with  not  more  than 
a  passing  benefit,  and  now,  by  the  transforming  influence 
of  endocrine  therapy,  plus  needed  associate  treatment,  were 
decisively  benefited  or  even  cured. 

The  most  valuable  organotherapeutic  remedy  in  psori- 
asis is  thyroid  extract,  and  the  dose  ranges  from  l-8th  to 
1/2  grain  three  times  a  day.  Where  the  patient  also  has 
a  syndrome  of  hypoadrenia — and  this  is  very  common  and 
easily  determined  by  finding  a  marked  asthenia,  low  blood- 
pressure,  deficient  circulation,  poor  elimination,  etc. — 

19 


290  PRACTICAL  ORGANOTHERAPY 

Adreno-Spermin  Co.  (Harrower),  combines  with  thyroid 
treatment  a  suitable  and  needed  adrenal  support  of  the 
increased  circulation  and  ensures  better  cellular  chemistry. 
This  favors  just  the  change  needed  to  reflect  itself  upon 
the  disordered  skin  functions.  In  psoriasis  this  treatment, 
coupled  with  purin-free  diet,  thorough  elimination,  and 
chrysarobin,  is  a  considerably  better  routine  than  to  depend 
upon  the  chrysarobin  alone,  as  has  been  the  manner  of 
some. 

The  one  thing  regarding  the  etiology  of  psoriasis  that  is 
supported  by  the  most  substantial  therapeutic  results  con- 
cerns its  metabolic  origin.  Many  times  it  has  been  found 
that  the  ingestion  of  certain  animal  nitrogen  products  pre- 
cipitates the  attack  or  prevents  its  recession.  A  diet  regu- 
lated upon  this  hypothesis  frequently  appears  to  modify  the 
progress  of  the  disfiguring  eruption.  As  we  have  seen,  the 
thyroid  has  a  marked  influence  upon  the  nitrogenous  met- 
abolism, and,  according  to  Cunningham,  "its  applicability 
therefore  to  the  treatment  of  psoriasis  would  seem  to  be 
perfectly  logical,  and  it  is  to  the  thyroid  that  the  empiri- 
cist-experimental clinician  should  turn  for  the  most  promis- 
ing lead  in  this  etiologic  hunt." 

Leopold  Levi  and  his  associate,  Baron  Henri  de  Roths- 
child, report  several  cases  of  psoriasis  which  were  associ- 
ated with  chronic  rheumatism  and  in  which  the  psoriasis 
completely  disappeared  under  thyroid  treatment.  (The  sub- 
ject of  the  important  endocrine  aspects  of  rheumatism,  as 
discussed  by  these  writers  and  others,  is  given  further  con- 
sideration in  Chapter  18,  of  this  section.) 

Finally,  Sir  Malcolm  Morris,  the  famous  British  derma- 
tologist, speaking  of  the  importance  of  the  thyroid  aspect  of 
psoriasis,  (Brit.  Med.  Jour.,  May  17,  1913),  remarks  that 
he  "has  found  thyroid  therapy  especially  efficacious  in  those 
cases  of  psoriasis  which  were  associated  with  adiposity"; 
in  other  words,  evidently  the  more  definitely  thyroid  cases. 
He  adds :  "In  no  skin  affection  has  thyroid  medication  given 
better  results  than  in  psoriasis,"  and  he  emphasizes  the 
fact  that  "whenever  cutaneous  affections  are  found  asso- 
ciated with  other  conditions  in  which  thyroid  is  indicated, 
there  is  a  presumption  in  favor  of  thyroid  treatment." 

Scleroderma  and  Ichthyosis:  The  superficial  resemblan- 
ces of  these  conditions  to  the  roughened  and  thickened  skin 
of  myxedema  has  prompted  many  to  attempt  thyroid  ther- 
apy, and,  in  a  proportion  of  cases,  the  results  have  been  quite 


ENDOCRINES  IN  DERMATOLOGY  291 

encouraging1,  more  especially  when  these  dermatoses  are 
found  in  children  and  infants.  In  passing,  it  is  particularly 
worth  while  to  consider  organotherapy  for  dermatoses  in 
children  who  manifest  other  evidences  of  endocrine  im- 
balance,and  it  is  equally  true  that  quite  a  number  of  develop- 
mentally  defective  children  known  to  be  suffering  from  dys- 
crinism  have,  in  addition,  various  more  or  less  intractable 
dermatoses,  especially  the  two  under  consideration  for  the 
moment.  Morris  reports  that  he  has  used  thyroid  in  a  num- 
ber of  cases  of  ichthyosis  "and  in  none  without  benefit." 
It  is  interesting  to  note,  in  passing,  that  this  writer  does 
not  hesitate  to  say  that  he  "has  been  especially  struck  by 
the  influence  of  thyroid  in  alleviating  pain  which  is  not  in- 
frequently a  symptom  of  keloid." 

My  advice  in  regard  to  the  treatment  of  xeroderma, 
scleroderma  and  other  similar  skin  affections,  where  thy- 
roid is  called  for,  is  to  use  Thyroid  Co.  (Harrower)  gr.  1/2, 
a  combination  of  an  official  tested  thyroid  product  with  the 
alkaline,  remineralizing  salts  (representing  those  found  in 
the  blood) — in  the  following  step-ladder  fashion:  For  ten 
days  or  two  weeks,  or  even  longer,  give  one  dose  a  day  at 
any  convenient  time.  For  a  similar  period,  ten  days  or 
more,  give  two  doses  a  day.  For  a  third  similar  period  give 
three  doses  a  day,  one  at  each  meal,  and,  if  it  seems  advis- 
able, for  a  fourth  period  give  four  doses  a  day.  During 
these  periods  of  gland  feeding  the  patient  should  be 
watched,  and  the  response  to  the  organotherapy  in  various 
ways  noted  carefully.  This  may  be  followed  by  a  rest  of 
the  same  length,  or  twice  as  long  as  each  10  or  15-day  per- 
iod, and  then  the  whole  thing  can  be  repeated.  In  many 
instances  benefit  will  be  seen  within  two  or  three  months; 
and  I  was  both  amused  and  pleased  just  the  other  day  to 
hear  a  prominent  sanitarium  superintendent  remark  over 
the  telephone  to  the  effect  that  Mrs.  Blank  "could  wrinkle 
her  face  again" — she  had  been  taking  for  about  3  months, 
a  treatment  which  I  had  recommended  for  scleroderma. 

Eczema.  Too  often,  eczema  is  an  infection  of  the  skin 
that  has  been  made  possible  by  a  particularly  lowered  re- 
sistance— many  times  of  endocrine  origin — for  the  capacity 
of  the  skin  to  function  normally  and  to  resist  infections 
is  related  to  a  normal  endocrine  service  to  the  body.  Ec- 
zema is  commonly  found  in  "run-down  individuals,"  and 
my  personal  opinion  is  that,  the  nutritive  and  circulatory 
influence  of  the  thyroid  and  allied  glands  upon  the  skin 
having  been  lessened,  lurking  infections  have  a  chance  to 


292  PRACTICAL  ORGANOTHERAPY 

take  hold  and  the  difficulty  assumes  a  double  aspect — in- 
fective as  well  as  nutritional.  Occasionally,  a  treatment 
directed  at  the  infective  aspects  of  eczema  is  eminently 
satisfactory,  but,  as  I  see  it,  the  advantage  in  many  in- 
stances is  as  much  due  to  the  associated  general  treatment, 
which  gives  the  regulating  endocrines  a  better  chance  to 
reassert  themselves,  as  is  always  the  case  when  the  emunc- 
tories  are  encouraged  and  elimination  is  better.  In  some 
cases  of  eczema,  on  the  other  hand,  "all  sorts  of  treatment" 
fail  miserably.  I  recall  the  incident  of  a  little  child  with 
a  terrible  eczema  of  the  scalp  which  was  perfectly  horrible 
to  look  at.  It  had  been  dusted  and  dabbed  and  daubed  for 
many  months  and  appeared  to  be  worse  than  ever  and  a 
source  of  great  discomfort  to  the  mother  as  it  must  have 
been  to  the  child.  It  was  cured  as  by  a  miracle  with  a  few 
weeks  of  thyroid  therapy,  and  incidentally  served  as  a 
means  to  the  physician's  conversion  to  the  possibilities  of 
organotherapy,  in  the  routine  use  of  which  he  is  now  an  en- 
thusiast. 

Still  another  youngster  of  three  of  four  years  had  eczema 
of  the  scalp,  which  had  been  a  source  of  great  concern  to 
the  physician  father.  This  child  was  said  to  have  never  had 
a  complete  night's  sleep  in  her  life.  When  she  did  get  to 
sleep  the  most  unusual  precautions  were  taken  to  prevent 
her  from  awakening,  because  it  was  known  that  another 
hour  or  two  would  be  spent  in  getting  her  to  sleep  again. 
I  went  out  to  see  her,  mentioned  to  the  parents  the  proba- 
bility of  the  thyroid  origin,  advised  suitable  thyroid  therapy 
and  alkalies  as  previously  mentioned,  and  she  was  well  in 
six  weeks,  much  to  the  amazement  of  all  her  relatives,  for 
her  condition  had  lasted  from  infancy. 

Eczema  in  children  apparently  has  a  larger  thyroid  phase 
than  eczema  in  adults,  and  the  results  are  comparatively 
better  the  younger  the  case.  In  adults,  on  the  other  hand, 
some  eczemas  apparently  are  not  likely  to  respond  to  thy- 
roid or  any  other  endocrine  therapy ;  but  since  one  cannot 
determine  this  in  advance,  it  seems  not  unreasonable — even 
though  quite  unscientific — to  give  these  patients  the  bene- 
fit of  organotherapeutic  treatment,  which  possibly  is  no 
more  scientific  than  recourse  to  any  other  unsatisfactory 
and  useless  measure,  and  most  of  the  patients  will  admit 
that  they  have  tried  many  measures  for  a  number  of  years 
with  considerable  misgivings,  but  usually  are  perfectly  will- 
ing to  have  another  "shot"  which  frequently  hits  the  mark. 


ENDOCRINES  IN  DERMATOLOGY  293 

Acne.  Acne  and  other  inflammatory  conditions  of  the  se- 
baceous and  sweat  glands  apparently  also  may  be  related 
to  dysthyroidism  in  the  same  manner  and  for  the  same  rea- 
sons discussed  under  subject  headings.  It  happens,  how- 
ever, that  in  many  instances  acne  also  is  related  to  a  change 
in  the  function  of  the  sex  glands,  which  may  account  for 
the  frequency  with  which  acne  is  found  at  puberty  in  boys 
and  in  relation  to  menstrual  difficulties  in  girls.  Local 
treatment  of  the  acne  is  quite  necessary,  the  expression  of 
the  comedones,  and  the  use  of  suitable  lotions,  are  perfectly 
in  order,  as  to  my  way  of  thinking,  is  suitable  vaccine  ther- 
apy ;  but  in  all  of  these  cases  there  is  good  reason  to  consider 
a  prospective  endocrine  basis,  and,  if  it  seems  advisable,  to 
treat  it  along  with  the  rest  of  the  patient.  Quite  a  number 
of  cases  of  acne  in  girls  have  been  cured  entirely  by  the 
regulation  of  an  associated  dysovarism  by  means  of  Thy- 
ro-Ovarian  Co.  (Harroiver) ,  so  much  so  that  some  phy- 
sicians have  come  to  consider  this  pluriglandular  formula  as 
a  remedy  for  acne  when,  in  point  of  fact,  it  is  not. 

Dermatoses  of  Ovarian  Origin.  The  relation  of  dys- 
ovarism to  skin  diseases  has  been  discovered  by  many  clini- 
cians. We  have  already  noted  the  frequency  with  which 
acne  may  be  related  to  menstrual  difficulties  in  girls,  and, 
among  a  number  of  writers,  Handler  believes  that  the  der- 
matoses  of  pregnancy,  menstrual  disturbances  and  the  cli- 
macterium  "are  of  the  same  kind  and  nature  as  those  oc- 
curring with  anomalies  of  menstruation  and  are  dependent 
on  altered  endocrine  secretions." 

Many  times  an  intractable  dermatosis  has  been  modified 
or  even  cured  in  conjunction  with  the  needed  regulation  of 
a  complex  based  upon  dysovarism.  Especially  is  this  true 
at  the  menopause.  Graves,  of  Boston,  reports  favorable 
experiences  with  ovarian  therapy  in  women  whose  dyscrin- 
ism  was  accompanied  by  such  skin  troubles  as  pruritus  vul- 
vae  and  severe  furunculosis  of  the  external  genitalia  of 
years  standing.  Several  other  writers  have  added  to  the 
consensus  of  opinion  that  certain  skin  diseases  occurring 
during  the  menopause,  as  eczema,  prurigo,  and  psoriasis, 
disappear  following  the  organotherapeutic  regulation  that 
is  demanded  in  such  cases. 

Circulatory  Skin  Conditions.  In  addition  to  the  disturb- 
ances already  mentioned,  several  other  derangements  of  the 
skin  must  be  considered  as  having  a  clear-cut  endocrine 
origin.  Scholtz,  a  leading  dermatologist  in  Los  Angeles, 
in  his  paper  "The  Skin  as  an  Index  to  Health"  (Med.  Rec- 


294  PRACTICAL  ORGANOTHERAPY 

ord,  May  15,  1920)  notes  that  "The  frequent  observance  of 
disorders  of  internal  secretions  in  a  very  large  clinical 
group  of  angioneurotic  dermatoses  ....  is  highly  sugges- 
tive of  the  close  association  and  correlation  of  the  sympa- 
thetic vasomotor  nervous  apparatus  and  the  ductless 
glands."  Raynaud's  disease,  and  even  the  localized  gan- 
grene, found  in  advanced  cases,  have  been  connected  with 
the  thyroid  and  cured  time  and  time  again.  Even  chilblains 
are  considered  as  definite  in  this  category.  According  to 
Cunningham  (N.  Y.  Med.  Jour.,  Jan.  19,  1918),  "erythema 
pernio  (or  chilblains)  is  so  clearly  a  circulatory  derange- 
ment that  involvement  of  the  adrenals  is  certain.  This  may 
be  due  to  toxemia,  to  which,  as  we  have  seen,  the  adrenals 
are  particularly  liable ;  it  may  be  due  to  thyroid  insufficiency 
reacting  upon  the  adrenal  glands."  Here  again,  the  met- 
abolism-stimulating, circulation-regulating  pluriglandular 
formula,  Adreno-Spermin  Co.  (Harrower) ,  has  been  used 
with  or  without  additional  therapy  in  circulatory  stasis  and 
localized  disturbances.  Since  the  endocrine  glands,  and  es- 
pecially the  thyroid  and  adrenals,  have  so  much  to  do  with 
vasomotor  control,  it  does  not  seem  so  unreasonable  to  con- 
sider disturbances  of  the  type  under  discussion  as  in  the 
nature  of  local  syncope,  associated,  perhaps,  with  a  local 
asphyxia,  as  Cunningham  calls  it. 

Pigmentary  Skin  Conditions.  Since  the  pigmentation  of 
the  skin  is  believed  to  be  modified  by  internal  secretory- 
functioning,  some  effort  has  been  made  to  translate  this 
to  therapeutic  advantage.  It  is  well  known  that  serious 
adrenal  diseases  are  connected  with  a  pigmentation  of 
greater  or  less  degree,  and,  in  certain  instances,  that  ad- 
renal therapy  (the  administration  of  adrenal  substance  by 
mouth)  has  been  followed  by  a  reduction  in  the  size  and 
color  of  the  pigmented  areas.  Handler  and  others  suggest 
that  the  pigmentary  signs  of  pregnancy  also  indicate  that  the 
gonad  function  may  be  concerned  in  the  normal  pigmenta- 
tion on  the  skin  and  that  there  may  be  a  gonad  aspect  to 
certain  pigmentary  difficulties.  It  is  well  known  also  that 
one  of  the  signs  of  myxedema  is  yellowish  coloration  of  the 
skin,  and  certain  French  investigators  report  that  abnormal 
conditions  of  pigmentation  are  beneficially  affected  by  thy- 
roid treatment,  even  indicating  that  leukoderma  may  be 
treated  with  advantage  by  thyroid  or  adrenal  therapy. 

Of  course,  so-called  "liver  spots"  or  chloasma,  and  the 
pigmentary  condition  of  the  face  described  by  some  as 
•"alimentary  pigmentation,"  usually  beginning  near  the  eye- 


ENDOCRINES  IN  DERMATOLOGY  295 

lids  and  spreading  gradually  over  the  face,  have  to  do  with 
the  detoxicating  organs,  chiefly  the  liver  and  the  thyroid 
and  many  times  are  remedied  by  a  generous  stimulation 
not  merely  of  the  digestive  organs — as,  for  example,  with 
Secretin  Co.  (Narrower)  (see  Section  V,  Chapter  24)  — 
but  also  by  step-ladder  dosage  of  thyroid,  as  mentioned 
previously.  All  of  this  emphasizes  our  need  for  study  of 
the  changes  that  the  thyroid  may  undergo  in  cases  of  intes- 
tinal toxemia,  and  the  importance  of  regulating  the  endo- 
crine aspects  of  this  most  common  occurrence. 

The  Hair  and  Nails.  Closely  related  to  the  disorders  of 
the  skin  are  disorders  of  its  appendages.  The  growth  of 
hair  is  certainly  in  some  way  connected  with  the  endocrines, 
and,  by  some,  baldness  is  said  to  be  due  to  hypocrinism, 
and,  on  the  other  hand,  hypertrichosis  to  an  excess  of 
certain  endocrine  activities,  especially  of  the  adrenal  cortex, 
and  perhaps  a  part  of  the  pituitary  gland.  Leopold  Levi 
reports  examples  of  the  advantages  of  thyroid  therapy  upon 
the  growth  and  color  of  the  hair,  and  according  to  Morris: 
"There  is  reason  to  believe  that  the  pituitary  and  the  ad- 
renals take  part  in  the  trichogenic  function,  and  it  has  long 
been  known  that  the  growth  of  hair  is  caused  directly  or 
indirectly  by  the  sexual  glands.  Some  incline  to  the  view 
that  the  thyroid  chiefly  influences  the  hair  and  scalp  while 
the  sexual  glands  affect  the  pubic  and  axillary  hair,  and  the 
beard." 

Urticaria  and  Herpes.  Attention  already  has  been  called 
to  the  responses  occasionally  found  in  the  skin  to  protein 
sensitization,  or  anaphylaxis  (see  Section  II,  Chapter  7). 
Apparently  the  skin  is  the  victim  of  circumstances,  and 
since  these  circumstances  involve  the  endocrines  in  a  way 
that  is  not  quite  clear,  but  which  has  been  discussed  pre- 
viously, when  one  is  confronted  by  a  condition  akin  to 
urticaria,  no  harm  can  come  from  extending  one's  know- 
ledge regarding  the  endocrine  aspects  of  the  case,  whether 
prominent  or  apparently  covered.  Tremendously  uncom- 
fortable wheals  of  urticaria  have  been  dissipated  in  10  min- 
utes by  hypodermic  injections  of  adrenalin  chloride,  5  to  8 
minims  of  a  1 : 1000  solution.  Urticaria,  and  especially  herpes 
zoster,  aggravated  at  or  near  the  menstrual  periods  or  of 
menopausal  origin,  has  been  entirely  cured  by  organother- 
apy directed  at  the  ovarian  imbalance — Thyro-Ovarian  Co. 
(Harrower) . 

Angioneurotic  Edema.  This  is  another  of  those  peculiar 
dermatoses  believed  to  be  related  to  endocrine  dysfunction 


296  PRACTICAL  ORGANOTHERAPY 

A  most  interesting  consideration  of  this  subject  appeared 
in  a. paper  by  Green,  of  Los  Angeles,  which  was  submitted 
in  the  first  Harrower  Prize  Contest  and  is  published  in 
"Essays  on  the  Internal  Secretions — 1920,"  page  273.  Ac- 
cording to  this  writer,  who  substantiates  his  opinion  with 
a  number  of  quotations  from  other  authors,  angioneurotic 
edema  is  believed  to  be  a  pluriglandular  hypersecretory 
syndrome  in  which  thyroid  excess  is  a  preliminary  feature 
and  adrenal  hyperactivity  the  secondary  and  predominat- 
ing characteristic.  The  treatment  recommended  should  be 
that  for  mild  hyperthyroidism.  Among  the  organothera- 
peutic  remedies  for  this  condition  is  pancreas  substance. 

Conclusions.  In  concluding  this  brief  consideration  of 
organotherapy  in  dermatology,  it  should  be  clear  that  the 
endocrine  glands  are  concerned  intimately  in  those  func- 
tions of  the  body  which  may  come  to  concern  the  skin,  and, 
further,  that  the  nutrition  and  circulation  of  the  skin  itself 
are  very  closely  under  the  control  of  those  glands.  Many 
dermatoses  are  of  pure  thyroid  origin.  The  circulatory- 
nutritive-metabolic  imbalance  of  the  thyroid  and  the  ad- 
renals, which  is  encouraged  by  pluriglandular  therapy- 
formula  Adreno-Spermin  Co.  (Harroiver) — is  often  related 
tc  the  cause  of  certain  dermatoses  and,  when  regulated, 
helps  to  dispose  of  them. 

Gonad  dysfunction,  too,  has  its  part  to  play,  not  merely 
in  the  direct  manner  suggested,  but  probably  also  because 
of  the  intimacy  between  the  thyroid  and  the  sex  glands. 

Finally,  as  Cunningham  says:  "In  endocrinology  will  be 
found  the  touchstone  of  dermatology,"  and  success  in  the 
treatment  of  dermatologic  disturbances  is  more  likely  to 
be  ensured  if  endocrinologic  derangements  previously  over- 
looked are  brought  into  prominence  and  then  properly  dis- 
posed of. 


SECTION  V.    CHAPTER  20 
ORGANOTHERAPY  IN  PROSTATIC  DISORDERS 


The  prostate  gland  is  one  of  the  least  understood  glands 
of  the  body,  at  least  insofar  as  any  possible  internal  secre- 
tory function  that  it  may  have  is  concerned,  and  in  regard 
to  its  relation  to  the  other  endocrine  organs  and  especially 
the  gonads.  Information  regarding  the  experimental  effects 


PROSTATIC   DISORDERS  297 

of  prostate  extracts  and  of  the  use  of  prostate  prepara- 
tions in  clinical  practice  indicates  that  there  are  certain 
therapeutic  possibilities,  but  the  subject  is  by  no  means  well 
understood,  and  this  statement  necessarily  must  be  incom- 
plete and  in  some  measure  indecisive. 

Certain  clinical  disturbances  of  the  prostate  undoubtedly 
are  associated  with  the  sex  manifestations,  and  it  is  fair 
to  presume  that  the  prostate  is  involved  in  the  reproductive 
function  in  a  considerably  broader  manner  than  its  pro- 
duction of  the  seminal  plasma. 

Prostate  Hypertrophy  as  a  Compensatory  Manifestation. 
The  fact  that  prostatic  hypertrophy  quite  commonly  follows 
the  functional  retirement  of  the  testes  would  indicate  that 
there  might  be  some  relationship  between  the  endocrine 
activities  of  both  these  glands.  It  has  been  suggested  that 
there  may  even  be  a  friendly  hyperactivity  of  the  prostate ; 
that  is,  when  the  testes  become  functionally  inactive,  the 
prostate  may  be  enlarged  in  a  compensatory  fashion,  just  as 
we  know  various  other  ductless  glands  may  enlarge  when 
other  closely  related  endocrine  organs  are  put  out  of  com- 
mission. At  least,  we  know  that,  provided  we  can  exclude 
deep-seated  and  overlooked  infective  processes  and  essential 
new  growths  of  the  gland  such  as  adenoma  or  cancer,  there 
evidently  is  a  form  of  enlargement  of  the  prostate  connected 
with  waning  gonad  function  which,  theoretically,  ought  to 
respond  to  an  organotherapy  which  would  supplement  the 
endocrine  function  of  the  testes  and  thereby  lessen  the  prob- 
able necessity  for  overactivity  on  the  part  of  the  prostate. 
The  idea  of  a  compensatory  prostatic  hypertrophy  is  not  yet 
a  proposition  accepted  by  urologists,  but  the  treatment  of 
it,  based  upon  the  outlined  idea,  has  been  most  encouraging. 
In  conjunction  with  several  prominent  genito-urinary  spe- 
cialists, a  special  formula  has  been  developed  in  my  labora- 
tory, called  Leydig-Cell  Co.  (Harroiver)  (No.  41),  the  es- 
sential basis  of  which  is  an  extract  of  the  interstitial  cells 
of  Leydig,  undoubtedly  a  useful  organotherapeutic  remedy 
since  these  cells  are  the  essential  structure  of  the  sex 
glands,  which  some  even  suggest  properly  might  correspond 
to  a  "male  corpus  luteum." 

Hypoprostatism  and  Neurasthenia.  A  number  of  reports 
in  the  ^  literature,  as  usual  especially  in  French,  state  that 
there  is  a  therapeutic  value  inherent  in  desiccated  pros- 
tate substance,  that  it  meets  the  expectations  of  a  homo- 
stimulant  gland  extract  and  is  therefore  likely  to  be  valuable 
in  conditions  of  prostatic  insufficiency.  It  has  been  re- 


298  PRACTICAL  ORGANOTHERAPY 

commended  chiefly  as  a  remedy  in  the  neurasthenic  mani- 
festations accompanying  prostatic  disease  and  following 
prostatectomy,  and  as  an  advantageous  addition  to  the 
Brown-Sequard  method  of  treatment  for  presenility,  impo- 
tence and  certain  functional  sex  neuroses.  Laignel-Lavas- 
tine,  a  famous  Parisian  neurologist,  tells  of  good  results 
from  this  procedure,  and  Beard,  Blanche  and  others  agree 
with  him. 

To  meet  a  demand  for  a  preparation  of  this  character, 
No.  48,  Prostate  Co.  (Harrower)  has  been  prepared,  each 
six  grains  of  which  contains  I1/-)  grains  each  of  the  desic- 
cated prostate  substance,  interstitial  cells  of  Ley  dig 
(spermin  extract)  and  lymphatic  gland  substance,  together 
with  an  effective  dose  of  nucleinic  acid.  The  latter  is  added 
because  of  its  leucocyte-stimulant  effect  and  its  well  known 
value  in  conditions  of  lowered  resistance  where  infections 
are  or  have  been  involved. 

A  personal  experience  with  this  was  quite  encouraging: 
The  patient,  an  old  soldier-chaplain,  age  81,  was  sent  to  me 
in  the  hope  that  something  might  be  done  to  relieve  him, 
for  after  long  periods  of  treatment  for  prostatic  and  urinary 
difficulties  he  was  in  a  deplorable  state.  I  am  not  a  genito- 
urinary man,  and  hesitated  to  have  anything  to  do  with 
such  a  case.  He  had  a  very  much  enlarged  prostate,  much 
urinary  difficulty  and  a  most  obstinate  form  of  constipa- 
tion. He  was  very  old  and  frail,  with  a  bad  heart  and  no 
leaning  to  surgery.  I  therefore  advised  the  Prostate  Co. 
on  what  I  called  "half  a  chance."  Here  is  a  report  which 
he  made  some  months  later:  "I  am  much  better.  There 
seems  to  be  more  'pep'  to  the  contractile  force  of  the  bowel 
and  less  obstruction  to  the  passage  of  feces.  A  noteworthy 
point  is  that  the  diameter  of  the  stool  is  much  larger  dur- 
ing each  course  of  the  capsules.  The  difficulty  with  urina- 
tion is  almost  gone,  and  with  two  or  three  short  excep- 
tions I  have  had  none  of  the  troubles  of  this  nature  (dysuria 
and  frequent  micturition)."  In  this  case,  there  was  a  de- 
cided reduction  in  prostatic  size  and  tenderness ;  the  results 
were  doubly  remarkable  because  of  the  age  and  condition 
of  the  patient.  Many  reports  convince  me  that  functional 
prostatic  disorders  have  been  benefited  by  the  use  of  this 
formula. 

A  Prostatic  Form  of  Impotence.  Another  practical  appli- 
cation of  prostatic  organotherapy  was  first  suggested  by 
Bazy.  He  found  it  valuable  in  "prostatic  impotence" — that 
form  of  sex  debility  in  which  prostatic  hypertrophy  and, 


PROSTATIC   DISORDERS  299 

hyperesthesia  was  or  had  been  prominent.  Usually  these 
cases  have  suffered  from  emissions,  premature  ejaculation 
and  the  usual  host  of  neuropsychoses  of  the  "sexual  neuras- 
thenic." In  developing  these  notions,  Reinert  found  that 
such  chronic  prostatic  enlargements  were  reduced  and  that 
simultaneously  urinary  retention  and  tenesmus  were  di- 
minished, while  in  j^ounger  cases  there  was  occasionally 
excellent  control  of  the  hyperesthesia  and  its  associated 
disturbances. 

Still  another  preparation  of  this  character  has  been  the 
subject  of  considerable  recent  study  and  clinical  applica- 
tion. Under  the  name  Gonad  Co.  (Harrower) ,  a  combina- 
tion similar  to  the  last  but  containing  in  addition  an  extract 
of  the  anterior  lobe  of  the  pituitary  gland,  has  been  made 
and  used  chiefly  for  the  attempted  reestablishment  of  lost 
sexual  powers,  with  an  aggregate  of  results  which  have 
made  a  number  of  those  using  it  remark  that  "it  is  the  most 
effective  thing  that  I  have  ever  used  or  recommended." 
This  particular  phase  of  organotherapy,  which  is  a  con- 
siderable advance  over  the  original  Sequardian  measure, 
is  more  thoroughly  discussed  in  the  following  chapter,  "The 
Hormones  in  Impotence." 

Limitations  of  Organotherapy.  In  closing,  it  should  be 
remembered  that  glandular  extracts  of  the  character  under 
consideration  exert  a  specific  influence  upon  the  glands  to 
which  they  correspond  and  must  not  be  expected  to  de- 
velop results  beyond  their  scope.  The  endocrine  function 
of  the  testes  is  not,  by  any  means,  its  spermatogenic  func- 
tion, though  doubtless  the  two  are  related,  and  the  rees- 
tablishment of  the  gonad  endocrine  function  does  not 
necessarily  involve  the  restoration  of  fecundity.  It  seems, 
however,  that  the  ductless  glands  involved  in  the  genera- 
tive process,  aside  from  the  gonads  or  essential  sex  glands, 
exert  a  paramount  influence  upon  the  effectiveness  of  these 
organs ;  and  it  has  been  shown  many  times  that  aspermia, 
as  well  as  Leydig  cell  incompetence,  has  been  reestablished 
by  thyroid  or  pituitary  medication,  hence  the  inclusion  of 
preparations  of  this  character  in*  a  remedy  from  which  one 
expects  tonic  qualities  is  in  order,  the  more  especially  when 
the  importance  of  the  anterior  lobe  of  the  pituitary  is  re- 
membered in  connection  with  gonad  development,  as  empha- 
sized by  Froehlich,  Bartels,  Gushing  and  many  others. 

Prostatic  troubles,  when  functional,  properly  may  include 
organotherapy,  for  the  results  may  not  be  merely  of  pros- 
pective help  to  the  patient,  but  of  diagnostic  value  also. 


300  PRACTICAL  ORGANOTHERAPY 

SECTION  V.    CHAPTER  21 
THE  HORMONES  IN  IMPOTENCE 


The  subject  under  consideration  still  may  be  considered 
by  some  to  be  "delicate"  and,  perhaps,  even  improper,  for, 
unfortunately,  traces  of  the  old-fashioned  prudery,  which 
has  left  its  mark  upon  the  civilized  peoples  of  this  world, 
still  remain. 

Gonad  Dysfunction.  However,  the  reproductive  organs, 
and  especially  the  sex  glands,  or  gonads,  like  other  glands 
of  internal  secretion,  are  subject  to  disorder  or  structural 
disease,  and  since  these  are  among  the  really  important 
glands  of  internal  secretion,  either  we  must  ignore  the  sub- 
ject as  some  may  do,  or  we  must  consider  it  as  probably 
worthy  of  careful  study  and  comment.  Many  seriously  im- 
portant factors  depend  upon  proper  gonad  functioning,  and, 
fortunately,  in  many  instances  these  are  amenable  to  indi- 
cated organotherapy.  It  is  proposed  to  call  attention  espe- 
cially to  the  possibilities  of  pluriglandular  therapy  in  modi- 
fying the  results  of  what  properly  may  be  called 
hypogonadism,  that  is,  reproductive  or  sexual  insufficiency. 

On  May  16th,  1888,  the  renowned  Brown-Sequard  demon- 
strated in  his  laboratory  in  Paris,  on  himself  as  the  subject, 
the  remarkable  results  following  the  use  of  a  pinkish  liquid 
obtained  from  the  testes  of  a  dog.  His  reports,  the  first 
of  which  was  made  to  the  Paris  Academy  of  Medicine  and 
published  in  his  own  Archives  de  Physiologic,  (1889  vol. 
xxvi,  p.  651;  also  p.  739),  were  really  the  beginning  of 
scientific  testicular  organotherapy,  although  there  are  ref- 
erences to  the  cruder  and  empirical  application  of  this  idea 
in  the  uncanonical  books  of  the  Bible  and  the  writings  of 
physicians  and  philosophers  thousands  of  years  ago. 

Unfortunately,  the  charlatans  of  Paris  promptly  seized 
upon  Brown-Sequard's  announcement,  seeing  therein  a 
chance  to  dupe  their  susceptible  cases  of  still  more  money, 
and  the  subject  shortly  "fell  into  disrepute  owing  to  the 
fact  that  the  noise  of  the  charlatans  squelched  the  real 
scientific  statements  of  this  famous  physiologist  and  his 
associates.  To  this  day  this  "black  eye"  has  remained,  and 
many  physicians  subconsciously  feel  that  testicular  opo- 
therapy  "savors  of  quackery." 

The  fact  remains  that  the  fundamental  principle  of  or- 
ganotherapy which  was  proved  by  Brown-Sequard  in  his 


HORMONES  IN  IMPOTENCE  301 

own  body  and  has  since  been  duplicated  times  innumerable 
by  reputable  physicians,  is  as  rational  and  physiologically 
sound  as  any  other  method  of  glandular  therapy.  It  has 
always  seemed  strange  to  me  how  willing  some  physicians 
are  to  use  ovarian  therapy  when  indicated  and  how  reticent 
they  are  about  the  use  of  "orchic  substance." 

The  Dynamogenic  Effect  of  Spermin.  Briefly,  this  form 
of  treatment  offers  two  important  therapeutic  possibili- 
ties: (1)  It  increases  dynamos — muscular,  nervous  and 
sexual ;  and  (2)  it  homostimulates  the  gonads  just  as  other 
endocrine  extracts  homostimulate  the  organs  corresponding 
to  those  from  which  they  were  made.  It  is  interesting  to 
recall  that  Brown-Sequard  found  a  marked  increase  in  his 
mental  and  physical  vigor — he  was  a  man  in  the  seventies 
— and  in  his  own  words,  "Considerable  laboratory  work 
hardly  produced  any  fatigue,  and  to  the  astonishment  of 
my  two  principal  assistants  and  other  persons  I  was  able 
to  carry  out  experiments  for  several  hours  in  a  standing 
position,  with  no  desire  to  be  seated."  The  dynamometer 
has  been  used  to  establish  this  fact  accurately,  and  Mosso's 
ergograph  has  shown  definite  dynamic  increases  following 
this  organotherapeutic  procedure. 

Despite  many  adverse  critisisms  there  is  quite  a  large 
literature  on  the  subject,  including  the  well-known  book  by 
Prof,  von  Poehl,  of  Petrograd,  who  a  number  of  years  later 
isolated  from  testicular  extract  a  crystalline  principle 
which  he  designated  "sperminum."  It  is  thought  to  be 
the  essential  stimulating  principle  in  this  extract,  and 
abundant  literature  exists  upon  its  pharmacodynamic  in- 
fluence. Gonadotherapy  accordingly  has  established  itself 
as  one  of  the  really  important  branches  of  hormone  therapy. 

The  disparaging  criticisms  referred  to  have  been  largely 
based,  to  my  way  of  thinking,  upon  the  foundation  to  which 
I  have  elsewhere  made  reference,  as  well  as  upon  the  fail- 
ures which  inevitably  must  follow  the  use  of  such  a  measure 
when  the  fundamental  causes  are  ignored  and  the  treatment 
continued  only  for  a  limited  time.  The  fact  remains  that 
two  thirds  of  the  unkind  things  said  about  organotherapy 
have  been  based  on  half-way  work  and  the  setting  of  one's 
hopes  too  high  and  testicular  organotherapy  is  one  form 
of  gland  feeding  upon  which  great  expectations  are  placed, 
while  being  in  many  cases  but  little  deserved. 

Quite  an  interest  was  aroused  at  the  time  by  the  publi- 
cation of  my  review  of  the  sixth  edition  of  Dr.  V.  G.  Vecki's 
splendid  work  on  "Sexual  Impotence."  He  is  a  pioneer  in 


302  PRACTICAL  ORGANOTHERAPY 

the  field  which  he  has  chosen,  and  his  book  is  worthy  of 
all  the  encomiums  that  I  can  write  about  it.  For  years 
we  groped  around,  but  now  endocrinological  studies  have 
established  many  facts,  determining  the  importance  of  the 
endocrines  in  gonad  dysfunction,  and,  as  Vecki  enumerates 
them,  it  is  clear  that  these  facts  establish  the  importance 
of  the  relations  of  these  glands.  For  instance,  he  brings 
proof  to  connect  the  pituitary  gland,  especially  the  anterior 
lobe,  with  gonad  development  and  function.  The  adrenals 
are  also  concerned,  especially  the  cortex.  "It  is  positively 
established  'that  the  thyroid  cells  form  an  internal  secre- 
tion, which  acts  as  a  chemical  stimulus  to  other  tissues/ 
though  Howell  cautiously  states  that  this  is  'usually  as- 
sumed/ '  The  importance  of  the  thymus  in  sex  develop- 
ment is  not  overlooked,  and  I  was  glad  to  see  that  Vecki 
has  found  a  persistent  thymus  as  playing  a  part  in  the  syn- 
drome of  hypogonadism,  just  as  I  have  many  times,  and  in 
both  sexes. 

Impotence  in  the  Male.  Much  interest  and  speculation 
in  regard  to  functional  agonadism  developed  as  a  result  of 
the  unwarranted  newspaper  notoriety  early  in  1920.  I  was 
compelled  to  work  overtime  answering  questions  about  the 
now-famous  "interstitial  glands/'  Too  much  has  been  pub- 
lished on  the  subject  and  the  hopes  of  too  many  have  been 
aroused  unfairly. 

I  want  to  emphasize  a  few  points  about  agonadism  with 
its  resultant  impotence.  First  of  all,  organotherapy  is  ef- 
fective in  proportion  to  the  reactivity  of  the  organism  to 
the  hormone  stimuli  that  may  be  represented  by  the  glandu- 
lar medication  that  is  given.  This  means  that  the  individual 
factor,  the  responsiveness  of  the  organs  to  homostimula- 
tion,  is  paramount.  If  the  testes  are  atrophied  or  senile, 
neither  transplantation  nor  organotherapy  can  be  of  the 
least  service.  If  there  is  a  structural  change  in  the  glands, 
as,  for  instance,  that  due  to  tuberculosis  or  a  tumor,  it  is 
not  likely  that  this  measure  will  be  beneficial. 

Again,  if  infective  causes,  especially  in  the  prostate,  epi- 
didymis  and  adnexa,  are  allowed  to  remain  hidden  and  un- 
treated, it  is  foolish  to  depend  upon  any  treatment,  no 
matter  how  prospectively  efficacious,  until  the  underlying 
conditions  are  discovered  and  remedied.  Another  very  im- 
portant factor  concerns  the  psychic  element.  Obviously,  un- 
controlled influences,  which  are  active  through  the  effects 
that  they  exert  through  mental  channels,  must  be  ruled 
out  or  overcome  before  a  functional  impotence  can  be  helped. 


HORMONES  IN  IMPOTENCE  303 

Of  course,  there  are  many  cases  of  asexualism  that  are 
purely  functional.  Cases  have  repeatedly  come  to  my  atten- 
tion when  a  severe  fright,  an  accident,  or  a  near  accident 
(where  a  serious  danger  was  narrowly  averted)  have  been 
definite  causative  factors.  Post-influenzal  impotence  is 
quite  common.  In  fact,  the  same  etiological  factors  may 
cause  functional  agonadism  with  a  resultant  impotence  as 
will  deplete  the  adrenals.  These  are  overactivity,  over- 
stimulation  by  toxemia,  especially  from  a  focus  of  infection, 
and  emotional  causes  such  as  fear,  etc. 

Perhaps  one  half  of  the  usual  grist  of  cases  are  purely 
endocrine,  and  hence  likely  to  respond  to  suitable  organo- 
therapy ;  but  this  is  not  saying  that  the  other  half  are  sure 
to  be  benefited,  for  they  are  not.  Sometimes  the  organo- 
therapeutic  regime  may  be  the  chief  means  of  differentiat- 
ing between  the  functional  and  responsive  form  of  impo- 
tence and  the  less  easily  modified  structural  cases. 

Another  important  point :  So  often  functional  impotence 
is  not  solely  a  disturbance  of  the  interstitial  cells  of  Leydig 
alone;  and  hundreds  of  clinical  tests  have  shown  that  to 
combine  with  spermin  (the  essential  active  element  of  the 
interstitial  cells)  the  synergists  from  the  anterior  lobe  of  the 
pituitary  gland,  the  thyroid  and  the  prostate,  makes  a  much 
more  likely-to-be-effective  remedy. 

Not  long  after  the  establishment  of  The  Harrower 
Laboratory,  several  years  ago,  I  was  invited  to  collabor- 
ate in  the  experimental  development  of  several  pluri- 
glandular  formulas  for  the  treatment  of  impotence 
and  asexualism.  Several  interested  genito-urinary  spe- 
cialists permitted  us  to  cooperate  with  them,  and  even- 
tually a  pluriglandular  formula  was  developed  which  since 
has  been  used  with  success  in  many  hundreds  of  cases.  This 
formula,  the  seventieth  experimental  preparation  made  in 
our  Glendale  laboratory,  is  called  Gonad  Co.  (Harrower) 
and  is  a  combination  of  several  products  of  closely  inter- 
acting endocrine  glands.  Let  it  be  said  here,  in  no  uncer- 
tain terms,  that  we  have  not  discovered  a  "cure  for  lost 
manhood."  Full  well  do  we  know  that  this  will  never 
emanate  from  any  laboratory,  for  the  personal  factor  far 
transcends  the  physiologic.  Nor  do  we  believe  that  it  will 
replace  worn-out  organs  or  reduce  the  age  of  those  who 
may  be  induced  to  take  it.  We  do  feel,  however,  judging 
from  the  encouraging  letters  and  appreciative  comments 
which  come  to  our  desk  from  month  to  month,  that  some- 
thing really  worth  while  is  being  accomplished.. 


304  PRACTICAL  ORGANOTHERAPY 

A  Brooklyn,  N.  Y.,  urologist,  who  helped  to  originate 
the  formula  just  referred  to,  and  who  has  given  the  subject 
much  study  and  practical  investigation,  argues — and  I  most 
thoroughly  agree  with  him — that  the  preparation  of  the 
essential  endocrine  cells  of  the  testes  (the  interstitial  cells 
of  Leydig,  as  they  are  called)  does  homostimulate  the  cor- 
responding cells  in  those  to  whom  it  is  given.  In  such  cases, 
the  addition  of  other  synergistic  gland  extracts  should  be 
helpful,  for  the  same  reason  that  combinations  of  various 
endocrine  products  excel  single  extracts  which  may  be  in- 
dicated in  other  disorders.  Among  the  most  obviously 
helpful  of  these  synergists  are  the  anterior  pituitary  gland, 
the  thyroid,  the  prostate,  and  the  lymphatic  glands,  for 
reasons  which  will  be  entered  into  below. 

The  reason  for  making  this  formula  so  comprehensive 
is  that  experimental-clinical  experiences  established  it  to 
be  more  effective  than  others  of  a  more  limited  character, 
and  to  satisfy  those  who  feel  that  this  may  be  a  "shotgun" 
preparation  the  following  fairly  reasonable  explanation  is 
made: 

In  impotence  there  is  usually  a  large  neurasthenic  ele- 
ment, for  obvious  reasons,  and  in  addition  to  an  asthenia 
of  gonad  function  there  is  certainly  a  "run-down"  condi- 
tion which  is  identical  in  character  with  the  adrenal  insuffi- 
ciency which  has  been  discussed  fully  in  other  articles.  In 
other  words,  the  majority  of  these  cases  require  adrenal 
support  and  should  have  it.  Hence  adrenal  substance  is 
one  of  the  ingredients  of  this  formula. 

There  is  another  important  reason,  which  is  found  in 
the  fact  that  the  adrenal  cortex  (adrenal  substance  con- 
tains about  85  per  cent,  of  adrenal  cortex  as  compared  with 
15  per  cent,  of  the  medulla)  is  recognized  as  playing  an 
important  part  in  the  development  of  the  gonads,  and  a 
dozen  or  more  references  in  the  literature  indicate  that  the 
corticular  principle  is  an  activator  not  merely  of  sex-gland 
development  but  of  its  function  as  well.  (Parenthetically, 
it  may  be  remarked  that  the  condition  known  as  "hyper- 
nephroma,"  in  which  there  is  an  enormous  hypertrophy  of 
the  adrenal  cortex,  usually  is  made  manifest  by  a  degree 
of  sexual  development  and  precocity  which  is  quite  out  of 
the  ordinary). 

Other  Endocrines  Which  Cooperate  With  the  Gonads. 
For  very  similar  reasons  thyroid  extract  is  a  part  of  the 
formula.  First  of  all  the  "condiment  value"  of  small  doses 
of  thyroid  in  pluriglandular  formulas  must  be  mentioned. 


HORMONES  IN  IMPOTENCE  305 

Hundreds  of  tests  have  proved  that  this  empirical  use  of 
thyroid  does  "bring  out  the  flavor"  just  as  a  condiment, 
and  adds  to  the  efficacy  of  the  formula.  Further,  in  as- 
thenia, hypothyroidism — even  though  it  may  be  of  a  minor 
type — is  an  important  possibility.  There  is  also  plenty  of 
evidence  to  indicate  that  the  thyroid  gland,  too,  is  a  respon- 
sible factor  in  initiating  and  maintaining  normal  gonad 
activity,  whether  in  the  male  or  female — else  v/hy  should  the 
cretin,  with  its  athyroidea,  have  no  noticeable  sexual  de- 
velopment? Further,  in  conditions  of  cell  laziness  and 
senility,  as  well  as  in  conditions  where  the  gonads  are 
below  par,  so  also  is  the  thyroid.  This  is  both  a  causative 
and  a  resultant  factor;  and  I  believe  that  a  small  dose  of 
thyroid  is  an  eminently  suitable  remedy  for  the  hypothyroid 
manifestations  of  the  asexual  as  well  as  in  the  elderly  indi- 
viduals whose  hormonic  functions  are  on  the  wane. 

We  now  come  to  one  of  the  really  important  phases  of 
this  subject.  The  pituitary  body,  especially  the  anterior — 
or  glandular — portion,  is  fully  as  important  a  factor  in 
the  development  and  maintenance  of  gonad  function  as  any 
other  endocrine  element.  This  has  been  proved  and  re- 
proved from  several  standpoints.  For  instance,  hypopitui- 
tarism — or  the  Froehlich  syndrome— frequently  known  as 
dystrophia  adiposo-genitalis,  always  includes  a  disturbance 
of  gonad  function.  This  aspect  of  these  cases  probably  is 
as  important  as  any  other,  for  infantilism — lack  of  the  de- 
velopment of  the  essential  sex  characteristics — may  be 
purely  of  pituitary  origin.  Again,  an  acquired  pituitary 
dystrophy  may  nullify  the  physiological  efficacy  of  the  al- 
ready established  gonad  function  and  not  merely  destroy 
the  hormone-producing  capacity  of  the  sex  glands,  but  actu- 
ally cause  an  atrophy  of  all  the  reproductive  organs  in  both 
sexes ;  and,  still  more  remarkable,  it  usually  causes  a  retro- 
gressive change  in  remotely  situated  locations  that  are 
known  to  be  related  to  those  developments  of  feature  and 
form  that  are  connected  with  puberty — that  period  of  initi- 
ation of  gonad  endocrine  activity. 

Now,  in  hypopituitarism,  pituitary  therapy  may  modify 
not  merely  the  pituitary  aspects  of  the  case,  but  the  gonads 
themselves  also,  and  this  method  of  treatment  is  recom- 
mended for  both  these  purposes.  Why  not,  then,  consider 
the  possibility  of  a  pituitary  aspect  of  asexualism,  even 
though  the  patient  may  not  have  well-defined  dyspituitar- 
ism  ?  As  a  matter  of  fact,  there  are  a  number  of  references 
in  the  literature  to  the  efficacy  of  anterior  pituitary  sub- 

20 


306  PRACTICAL  ORGANOTHERAPY 

stance  as  a  sex  stimulant,  and  reports  in  the  literature  indi- 
cate that  impotence  in  both  sexes  has  been  benefited  by  this 
method  alone. 

It  has  seemed  that  the  prostate  gland  is  involved  in  many 
cases  of  functional  impotence  and  that  prostatic  therapy 
has  been  beneficial,  especially  in  those  forms  of  impotence 
that  are  related  to  a  demonstrable  disturbance  in  prostatic 
form  and  activity.  The  prostate  is,  indeed,  a  gland  which 
has  some  broader  physiologic  influence  than  the  production 
of  its  seminal  secretion.  Many  writers  believe  that  it  is 
a  real  endocrine  organ ;  and  experience  shows  that  to  add 
prostatic  extract  to  the  other  gonadostimulant  extracts  (as, 
for  instance,  those  just  mentioned)  is  worth  while.  Hence, 
this  substance  has  likewise  been  added  to  the  formula. 

Finally,  and  most  important,  the  gonad  principle  known 
as  spermin  (referred  to  above) ,  which  is  made  from  the  in- 
terstitial cells  of  Leydig — the  essential  endocrine  cells  of  the 
testes — is  as  essential  a  part  of  this  formula  as  any,  and  is 
given,  naturally,  for  its  general  dynamic  influence  as  well  as 
its  specific  homostimulative  influence  (already  referred  to) 
upon  the  interstitial  cells  of  Leydig  in  the  individual  to  be 
treated. 

Treating  an  Endocrine  Complex.  Pluriglandular  therapy 
of  this  type  is  directed  at  all  the  real  or  prospective  causes 
of  a  functional  hypogonadism.  Not  merely  are  the  essen- 
tial Leydig  cells  stimulated  directly,  but  the  effort  is  made 
to  modify  those  factors  which  may  be  fundamentally  the 
cause  of  the  hypogonadism,  notably  in  the  anterior — or 
glandular — lobe  of  the  pituitary  and  the  prostate,  while 
the  association  of  the  general  toning  and  cell-stimulating 
influence  from  suitable  doses  of  adrenal  and  thyroid  makes 
a  combination  that  is  really  hard  to  beat  in  the  treatment 
of  functional  impotence. 

However,  this  treatment,  while  successful  in  many  in- 
stances, fails  almost  as  often,  and  I  cannot  refrain  from 
lending  decided  emphasis  to  the  necessity  for  careful  selec- 
tion of  cases  suitable  for  this  method  of  therapy,  and  for 
good  diagnostic  work. 

If  local  treatment  is  necessary  and  is  not  given,  surely 
organotherapy  will  not  accomplish  the  desired  end.  If 
there  is  a  structural  difficulty,  as,  for  example,  an  organic 
destruction  of  tissue,  organotherapy  cannot  be  of  homo- 
stimulative  value  under  such  circumstances. 

The  treatment  of  impotence,  to  my  mind,  involves  a  good 
deal  more  than  organotherapeutic  stimulation  and  must 


HORMONES  IN  IMPOTENCE  307 

not  be  expected  to  render  the  slightest  service  when  there 
is  a  psychic  element  at  the  bottom  of  the  trouble  or  a  hid- 
den infection  which  has  been  entirely  overlooked.  Organo- 
therapy is  effective  in  endocrine  trouble.  When  impotence 
is  the  result  of  endocrine  insufficiency  of  not  merely  the 
sex  glands  but  of  the  glands  which  are  responsible  for 
initiating  their  activities,  notably  the  pituitary,  adrenals 
and  thyroid,  then  pluriglandular  therapy  is  most  likely  to 
render  results.  Gonad  Co.  (Narrower)  is  the  most  effi- 
cient organotherapeutic  measure  for  the  treatment  of  impo- 
tence that  I  have  ever  seen  or  heard  of.  Hence,  in  cases 
of  impotence,  it  is  very  necessary  to  rule  out  associated 
factors  that  are  not  of  an  endocrine  character  before  offer- 
ing hope  from  pluriglandular  therapy.  And  too  much  em- 
phasis cannot  be  laid  upon  this  aspect  of  the  treatment  of 
such  cases. 

The  Most  Suitable  Cases.  The  cases  of  impotence  that 
respond  best  to  organotherapy  are  the  functional  ones  that 
have  followed  a  severe  infection,  as  influenza,  severe  intoxi- 
cations, either  wilful  (drug  addicts)  or  accidental,  and  the 
large  class  in  which  a  developmental  factor  of  unknown 
origin  has  interfered  with  complete  functional  develop- 
ment of  these  organs.  Sad  to  relate,  there  is  quite  a  large 
class — which  includes  the  senile  and  the  roue — who  do  not 
deserve  to  regain  their  lost  virility,  which  has  been  misused, 
although  in  these  cases  organotherapy  has  been  used  with 
results  equally  as  good  as  those  we  expect  from  homostimu- 
lative  organotherapy  of  any  other  endocrine  organ  that  has 
been  functionally  overworked  and  played  out,  as,  for  ex- 
ample, the  adrenals.  The  fact  remains,  however,  that  just 
as  the  alcoholic's  liver  is  most  obstinate  to  the  best  of  treat- 
ment, so  the  gonads  of  his  fast-living  associates  cannot  be 
expected  to  live  up  to  the  abnormal  demands  made  upon 
them  and  may  not  respond  to  the  best  of  treatment.  The 
underlying  principle  of  organotherapy,  however,  remains. 
Consequently,  other  things  being  equal,  and  provided  that 
circumstances  can  be  made  half-way  favorable,  there  is 
greater  hope  for  the  reestablishment  of  gonad  endocrine 
function  from  organotherapy  than  from  all  the  phosphorus, 
damiana  and  nux  in  the  world;  for  hormone  therapy  has 
one  great  thing  in  its  favor:  it  is  a  natural  method. 

Most  of  the  cases  in  whom  Gonad  Co.  (Narrower)  has 
been  used  were  old  chronic  cases  who  had  been  treated  pre- 
viously without  satisfactory  results.  I  am  assured  that 
many  of  them  had  long  since  been  given  up,  and  reestablish-- 


308  PRACTICAL  ORGANOTHERAPY 

ment  of  those  factors  which  are  dependent  upon  normal 
sex  function — general,  chemical  and  reproductive — is  just 
as  possible  in  cases  of  impotence  due  to  hypocrinism  as  the 
reestablishment  of  a  deficient  menstruation  following  suit- 
able organotherapy,  or  the  control  of  other  dystrophies 
which  may  be  due  to  glandular  insufficiency.  This  puts  a 
new  and  more  encouraging  aspect  upon  a  subject  which  is 
unfortunate,  to  say  the  least.  Even  if  we  have  not  found 
Ponce  de  Leon's  long-sought  Elixir  Vitae,  the  prospects  are 
better  than  heretofore  merely  because  we  have  acquired  a 
broader  viewpoint,  and  are  now  willing  to  treat  not  merely 
the  victims  of  the  circumstances — the  gonads  themselves— 
but  the  associated  factors  which  may  be  just  as  responsible 
for  the  difficulty.  Gonad  Co.  is  given  in  doses  of  5  or  10 
grains  three  times  a  day,  usually  for  some  weeks  or  months. 
It  should  be  given  as  a  part  of  the  treatment  of  a  given  case. 
Causative  factors — infective  or  psychic — should  be  con- 
trolled, for  obviously  no  form  of  therapeutics  not  directed 
at  these  could  be  expected  to  be  resultful. 

Treatment  of  this  type  should  be  considered  as  experi- 
mental. It  is  not  always  possible  to  determine  in  advance 
whether  a  given  case  is  purely  functional  or  whether  there 
may  not  be  some  organic  or  extraneous  circumstance  that 
will  militate  against  success.  One  thing  is  certain:  that 
the  broadening  of  organotherapy  by  making  the  right  com- 
bination of  the  associated  glandular  substances  is  nowhere 
more  obvious  than  in  the  treatment  of  impotence  with  this 
pluriglandular  formula.  To  say  the  least,  it  is  worthy  of 
consideration,  especially  when  both  physician  and  patient 
usually  are  decidedly  "up  against  it,"  as  so  frequently  is 
the  case  in  such  conditions. 


SECTION  V.    CHAPTER  22 
INTESTINAL  STASIS  AND  INTERNAL  SECRETIONS 


Sir  Arbuthnot  Lane,  of  London,  who  has  prominently 
brought  forward  certain  phases  of  the  subject  of  intestinal 
stasis,  repeatedly  has  called  attention  to  the  frequent  endo- 
crine manifestations  associated  with  this  common  syn- 
drome. These  are  naturally  the  result  of  the  absorption  of 
poisons  and  this  toxemia,  in  turn,  is  responsible  for  further 
endocrine  dysfunction  which  causes  certain  symptoms  and, 


INTESTINAL  STASIS  309 

at  the  same  time,  aggravates  the  disturbed  cellular  chem- 
istry, thereby  making  a  vicious  circle. 

It  is  well  known  that  moderate  forms  of  hypothyroidism, 
for  instance  the  so-called  "myxedeme  fruste,"  causes  a  seri- 
ous cellular  infiltration  which  affects  the  whole  alimentary 
tract  with  the  rest  of  the  body,  thus  favoring  an  atonic  and 
functionally  inactive  state  which  speedily  becomes  a  me- 
chanical as  well  as  secretory  condition.  Attention  has  been 
frequently  called  to  the  baneful  effect  of  the  chronic  toxe- 
mia of  intestinal  stasis  upon  the  endocrine  organs  and  es- 
pecially the  adrenal  glands. 

With  this  brief  introduction  in  mind,  relaxed  abdominal 
walls,  visceral  ptosis  and  intestinal  stasis  must  not  be  con- 
sidered as  purely  abdominal  lesions  of  anatomical  interest. 
Mineral  oil  may  be  well  enough  as  a  remedy ;  but  it  does  not 
get  far  beyond  the  intraintestinal  conditions.  Surgery  may 
be  well  enough,  too,  but  it  does  not  reach  much  further  than 
the  local,  anatomical  trouble. 

The  Endocrine  Aspect.  There  is  a  side  to  the  study  of 
the  symptomatology  of  enteroptosis  that  should  be  worthy 
of  attention  equally  with  the  strictly  anatomical  disorder — 
the  undoubted  effects  of  the  associated  chronic  toxemia 
upon  the  glands  of  internal  secretion. 

There  never  was  a  case  of  chronic  intestinal  stasis,  or 
Lane's  disease,  whose  hormone  production  was  at  par. 
Pluriglandular  insufficiency  or  hypocrinism  is  an  inevitable 
concomitant  of  any  prolonged  toxemia  of  whatever  di- 
scription  or  origin,  just  as  toxemia  is  inevitable  with  intes- 
tinal stasis.  So  in  order  to  do  justice  to  this  large  class  we 
must  also  consider  the  endocrine  side  of  these  cases,  and  in 
so  doing  we  will  assuredly  uncover  additional  possibilities 
for  effective  treatment. 

Comparatively  recently,  Dr.  V.  Pauchet,  of  Paris,  has 
given  this  subject  some  study  and  in  the  Presse  Medicale 
(April  11,  1918,  p.  189)  he  has  demonstrated  very  clearly 
that  gastro-entero-coloptosis  causes  a  complex  pathologic 
condition  including  insufficiency  of  the  glands  of  the  ab- 
domen (liver,  adrenals,  etc.),  degeneration  of  tissue  and  an 
unstable  sympathetic  nervous  system.  This  refers  prin- 
cipally to  functions  which  are  under  the  control  of  the  ad- 
renal hormones  and  accounts  for  many  of  the  sympathetic 
manifestations  which  accompany  and  are  an  indirect  result 
of  this  ptosis.  According  to  Pauchet,  persons  with  ptosis 
need  to  be  treated  for  months  or  years  to  correct  these  endo- 
crine disturbances  and  he  recommends  hepatic  and  adrenal 


310  PRACTICAL  ORGANOTHERAPY 

organotherapy  as  well  as  a  general  hygienic  regime  includ- 
ing physical  culture,  exercise  and  massage  with  an  outdoor 
life,  psychic  reeducation,  etc. 

Pauchet  then  outlines  his  surgical  measures,  which  do 
not  interest  us  for  the  moment ;  but  I  will  take  the  oppor- 
tunity to  direct  attention  to  the  organotherapeutic  phase 
of  this  subject  and  will  emphasize  its  possibilities  as  an 
adjuvant  measure  in  the  treatment  of  intestinal  stasis. 
Parenthetically  let  me  say  this :  Organotherapy  often  is  of 
service  in  conjunction  with  other  indicated  measures  and 
very  rarely  is  useful  alone.  In  fact,  this  is  really  a  rule, 
for  in  most  instances  where  organotherapeutic  extracts  or 
combinations  are  indicated  practically  always  they  should 
be  supplementary  to  such  other  treatment  as  circumstances 
may  direct. 

So  when  the  toxemia  has  reduced  the  effectiveness  of  the 
glands  of  internal  secretion  and  the  ptosis  is  accompanied 
by  such  common  symptoms  as  easy  fatigue,  severe  asthenia, 
subnormal  temperatures,  especially  in  the  mornings,  mal- 
nutrition and  the  so-called  "neuro-circulatory  asthenia" 
(with  cardiac  asthenia,  hypotension  and  cold  extremities, 
etc.),  surely  one  is  justified  in  attempting  to  augment  the 
endocrine  deficiency  by  suitable  gland  feeding. 

It  is  generally  admitted  that  toxemia  of  intestinal  stasis 
has  a  greater  influence  for  evil  than  the  mechanical  or  ana- 
tomic factors.  It  must  be  controlled  by  intestinal  antisep- 
sis, diet  and  other  indicated  treatment.  Organotherapy 
will  not  accomplish  this.  Incidentally,  among  some  printed 
instruction  slips  which  I  use  in  my  consultation  work,  are 
two  which  I  will  reprint  here,  as  they  are  often  quite  help- 
ful in  this  particular  connection : 

Intestinal  Flushing.  The  lower  bowel  is  often  a  source 
of  much  toxemia  and  its  proper  care  may  greatly  help  other 
treatment  which  may  be  needed.  The  high  enema,  consist- 
ing of  a  quart  of  lukewarm  water  in  which  a  teaspoonf  ul 
of  common  salt  has  been  dissolved,  is  an  excellent  prelim- 
inary treatment. 

This  may  be  introduced  into  the  colon  from  a  fountain- 
or  bulb-syringe  and  should  be  allowed  to  pass  in  very  slowly 
and  be  retained  for  at  least  fifteen  minutes  by  the  clock, 
preferably  while  lying  down.  During  this  time  it  is  best 
first  to  lie  on  the  back  with  the  hips  raised  and  later  on  the 
right  side  and  to  manipulate  the  abdomen  gently,  com- 
mencing at  the  lower  left  side,  running  up  to  the  ribs  and 
down  on  the  lower  right  side.  Often  this  procedure  merely 


INTESTINAL  STASIS  311 

loosens  the  easily  removed  feces  and  an  oil  enema  is  advis- 
able, for  the  oil  gets  into  the  kinks  and  crevices.  This  is 
given  with  a  bulb  syringe  preferably  following  the  cleans- 
ing enema  referred  to  above. 

Secure  one  pint  of  any  vegetable  oil — olive,  almond  or 
cotton-seed.  Place  the  bottle  in  warm  water  until  the  oil 
is  at  body  heat,  divide  the  bottle  into  thirds  by  marks  on 
the  outside,  then  place  one  end  of  the  bulb  enema  outfit 
into  the  oil,  squeeze  the  bulb  to  empty  the  air,  insert  the 
nozzle  and  slowly  inject  about  one  third  of  the  oil  into  the 
rectum.  The  previously  mentioned  positions  should  be 
taken  and  the  oil  held  in  all  night  (sometimes  it  is  neces- 
sary to  use  a  cloth  to  protect  the  clothing).  Repeat  this 
procedure  on  the  two  following  nights,  noting  the  amount 
and  character  of  the  stools  passed  the  next  days. 

In  cases  of  severe  intestinal  irritation  it  is  an  advantage 
to  replace  one  ounce  of  the  pint  of  oil  by  one  ounce  of  isarol 
(or  icthyonat),  as  this  has  an  antiseptic  and  soothing  in- 
fluence. 

Light  Exercises  for  Strengthening  the  Abdomen.  1.  Lie 
flat  on  the  back  (with  bladder  empty)  with  knees  bent. 
Gently  stroke  the  abdomen  downward,  6  times,  along  the 
inside  of  the  left  hip,  from  ribs  to  pelvis. 

2.  Stroke  3  times  across  the  abdomen  on  the  navel  line 
from  the  top  of  right  hip  to  top  of  left,  then  downward  as 
in  (1). 

3.  Draw  the  lower  abdomen  forcibly  inward  by  muscle 
contraction  (not  by  breathing) ,  and  imitate  the  movement 
involuntarily  made  in  taking  a  long,  restful  yawn — breathe 
in  slowly  all  the  air  possible,  stretching  the  trunk  and  neck 
forward,  then  as  slowly  breathe  out  all  the  air  taken  in,  re- 
laxing the  body  fully.    Repeat  6  or  8  times.     (This  exer- 
cise also  may  be  taken  sitting  or  standing  and  may  be 
repeated  often  with  advantage.) 

4.  Forcibly  draw  in  the  lower  abdominal  wall  (by  muscle 
contraction),  then  raise  it  and  hold  long  enough  to  count 
ten.    Do  this  three  times.    Rest  and  repeat. 

5.  Repeat  the  series  after  becoming  accustomed  to  the 
exercise,  but  do  not  tire  yourself.     Do  not  apply  pressure 
below  and  to  the  inside  of  the  right  hip  (region  of  the  ap- 
pendix) . 

These  exercises  should  be  taken  on  retiring,  to  overcome 
the  sagging  of  abdominal  organs  due  to  the  standing  an 
sitting  posture.  They  may  be  repeated  half  an  hour  <y»* " 
before  meals,  if  indigestion  and  gas  are 


312  PRACTICAL  ORGANOTHERAPY 

The  simple  instructions  have  proved  quite  helpful  and 
despite  their  elementary  character  I  find  that  when  they  are 
faithfully  put  into  practice  it  makes  a  great  difference  in 
the  routine  treatment 

Thyroid  and  Intestinal  Stasis.  In  a  paper  in  The  Prac- 
titioner (London),  for  August,  1920,  Stiell  in  discussing 
the  advisability  of  the  removal  of  the  colon  for  intestinal 
stasis,  asserts  that  the  control  of  toxemia  is  a  yery  much 
more  rational  method.  He  states  that  the  administration 
of  thyroid  extract  is  a  more  reasonable  procedure,  since 
in  many  instances  the  stasis  may  be  due  to  an  impaired 
muscular  contraction  from  a  chronic  myxedematous  infla- 
tion of  the  muscles  of  the  bowel  wall.  Stiell  refers  to  the 
work  of  Hertoghe,  of  Antwerp,  who  has  exhibited  dozens 
of  cases  of  intestinal  stasis  entirely  cured  by  the  judicious 
administration  of  thyroid  extract,  and  suggests  that  the  im- 
provement of  chronic  constipation,  headache,  and  lassitude, 
which  is  experienced  by  a  large  number  of  women  follow- 
ing ovarian  activity,  may  be  due  to  the  stimulating  effect 
that  these  factors  have  upon  thyroid  activity. 

I  have  frequently  called  the  attention  of  the  profession  to 
the  importance  of  this  infiltration  and  have  referred  to  it  in 
many  differing  and  widely  separated  aspects  of  medicine. 
This  infiltration  of  thyroid  origin  is  an  extremely  im- 
portant factor  in  alimentary  disorder. 

The  Thyroid  Function  Test  is  Helpful.  As  has  been  stated, 
hypothyroidism  is  a  common  concomitant  of  intestinal 
stasis.  It  may  be  the  essential  cause  of  the  whole  trouble. 
On  the  other  hand  it  may  be  a  result  of  the  associated  tox- 
emia. No  matter  whether  the  thyroid  element  is  causative 
or  resultant,  it  is  well  to  look  into  the  thyroid  aspect  of 
these  cases,  and  especially  those  whose  appearance  is  sallow, 
whose  circulation  is  sluggish  and  who  may  also  be  suffering 
from  various  dermatoses.  Under  such  circumstances  it  is 
helpful  to  use  my  Thyroid  Function  Test,  by  means  of  which 
a  fairly  accurate  estimate  may  be  made  of  the  secretory 
apathy  or  sensitiveness  of  the  gland.  This  is  explained 
elsewhere  in  this  book.  When  the  chart  shows  a  lazy  thy- 
roid, surely  the  best  treatment  for  the  stasis  would  be  in- 
complete without  attention  to  this  factor  which,  by  the 
way,  is  commonly  ignored  altogether.  - 

The  Frequency  of  Asthenia.    The  most  common  symptom 

f  intestinal  stasis  is  asthenia.    The  fatigue  syndrome  may 

~chadow  all  the  other  symptoms.     These  patients  are 

^  they  get  up  in  the  morning,  tired  all  day  and 


INTESTINAL  STASIS  313 

more  tired  when  they  go  to  bed ;  and  the  toxemia  and  other 
conditions  accompanying  the  tiredness  many  times  have 
caused  such  a  change  in  the  blood  that  instead  of  carrying 
off  the  wastes  from  the  brain  it  is  actually  irritating  the 
brain  cells  and  insomnia  results.  It  is,  in  fact,  a  common 
finding  in  intestinal  stasis. 

As  I  have  emphasized  in  the  first  chapter  of  this  section, 
asthenia  is  the  chief  indicator  of  the  presence  of  adrenal 
insufficiency;  and  it  happens  that  adrenal  insufficiency  is 
a  much  more  usual  result  of  intestinal  stasis  than  dysfunc- 
tion in  any  of  the  other  endocrine  glands,  though  the  trouble 
is  so  thorough  in  its  bad  work  that  the  patient  with 
stasis  may  have  any  kind  of  endocrine  disturbance,  includ- 
ing the  adrenal  and  thyroid  difficulties  already  mentioned, 
pituitary,  hepatic  and,  especially,  ovarian  disorders. 

If  every  patient  with  intestinal  stasis  is  likely  to  have  a 
more  or  less  serious  hypoadrenia,  pains  should  be  taken  to 
estimate  the  blood-pressure,  study  the  temperature  curve, 
especially  in  the  morning  for  a  few  days,  and  learn  the 
amount  of  urinary  solids,  particularly  urea.  It  will  be  found 
that  practically  90  per  cent,  of  these  individuals  have  low 
systolic  pressure,  subnormal  temperature  and  a  markedly 
decreased  elimination  of  solids.  In  other  words,  they 
have  the  typical  syndrome  of  hypoadrenia  which  deserves 
to  be  considered  and  treated  equally  with  the  alimentary 
difficulty. 

Organotherapeutic  Suggestions.  A  few  words  about  the 
organotherapy  of  intestinal  stasis  are  now  in  order.  It 
certainly  is  a  helpful  measure  in  the  treatment  of  the  nat- 
ural results  of  alimentary  toxemia  and  stasis.  The  French 
urge  hepatic  therapy  as  a  fundamental  method,  as  it  em- 
bodies the  ideal  hepatobiliary  stimulant,  and  in  France 
"opotherapie  hepatique"  is  very  much  more  usual  than  here. 
They  also  routinely  use  adrenal  extract  in  hypoadrenia,  and 
combinations  of  these  glands  are  used  with  success.  It  is 
indeed  good  policy  to  look  at  this  side  of  these  cases. 

To  tell  the  truth,  most  of  my  ideas  concerning  organo- 
therapy, and  particularly  the  combining  of  synergistic 
gland  extracts,  came  as  a  result  of  what  I  saw  and  heard 
during  several  visits  to  Paris ;  and  one  of  these  ideas  em- 
bodied in  the  formula  known  as  Hepato-Splenic  Co.  (Nar- 
rower) is  worthy  of  consideration  in  cases  such  as  Pauchet 
has  mentioned.  This  formula  (No.  5  on  our  list)  contains 
two  grains  each  of  the  desiccated  extracts  of  hepatic  and 
splenic  parenchyma,  one  grain  of  spermin  extract  which 


314  PRACTICAL  ORGANOTHERAPY 

represents  approximately  nine  grains  of  fresh  Leydig  cells 
(from  the  testes),  one  quarter  of  a  grain  of  desiccated 
adrenal  substance  and  a  twentieth  of  a  grain  of  thyroid 
(U.  S.  P.).  This  makes  a  good  "shotgun  mixture/'  which, 
besides  encouraging  the  reestablishment  of  the  very  ali- 
mentary functions  which  are  so  usually  deranged  in  these 
cases,  supports  the  adrenal  glands  and  exerts  an  antitoxic 
and  trophogenic  influence  of  value  in  modifying  conditions 
so  usually  untreated  in  many  cases  of  chronic  intestinal 
stasis.  The  dose  is  preferably  ten  grains  between  meals 
three  times  a  day  for  some  weeks,  to  be  reduced  later  to 
one  dose  four  times  a  day  for  a  further  period ;  and  always 
as  a  part  of  a  painstaking  and  persistent  therapeutic 
regimen. 

Biliary  Stimulation.  Sometimes  it  may  be  advisable  to  in- 
stitute more  active  treatment  directed  at  the  biliary  stasis, 
in  which  case  the  Bile  Salts  Co.  (Harrower)  (No.  22)  may 
be  administered  in  the  step-ladder  fashion  suggested  in 
Chapter  13  of  this  section.  Again,  the  alimentary  paresis 
may  be  so  severe  that  nothing  short  of  drastic  measures 
must  be  followed  out,  and  here  it  is  well  to  give  hypodermic 
injections  of  Liquor  Hypophysis  U.  S.  P.  (Harrower) .  I 
recommended  one  half  a  mil.  daily  or  every  other  day  for 
a  week  or  two.  It  certainly  stimulates  the  atonic  intestinal 
musculature. 

To  recapitulate :  Study  the  endocrine  aspects  of  intestinal 
stasis.  Find  out  if  there  is  an  associated  hypothyroidism, 
and  treat  it.  If  the  bile  is  deficient,  help  the  body  to  make 
more  by  giving  Bile  Salts  Co.  as  advised.  If  the  intestinal 
atony  is  marked  use  the  posterior  pituitary  principle  to 
initiate  the  treatment  and  continue  it  for  a  week  or  two. 
If  there  is  hypoadrenia  present  push  "the  best  remedy  for 
adrenal  support" — Adreno-Spermin  Co.  (Harrower),  giv- 
ing two  with  each  meal  and  at  bedtime  for  two  weeks ;  then 
reduce  to  one,  q.  i.  d.  Later,  in  the  majority  of  cases,  the 
Hepato-Splenic  Co.  contains  enough  of  the  adrenal  support- 
ive elements  plus  hepatobiliary  stimulants  to  serve  well, 
and  this  may  be  given  in  place  of  the  Adreno-Spermin  Co., 
and  in  the  same  dosage. 

The  Effects  of  Secretin.  Still  another  possibility  in  the 
organotherapeutic  treatment  of  intestinal  stasis  is  repre- 
sented by  secretin-bearing  extracts.  There  may  be  a  de- 
cided deficiency  in  the  production  of  this  alimentary  activa- 
tor and  in  cases  with  gastric  insufficiency,  hypochlorhydria, 
and  the  resultant  defective  duodenal  functioning,  Secretin 


Mucous  COLITIS  315 

Co.  (Harrower)  has  been  known  to  be  helpful.  The  phy- 
siology of  the  hormone  secretin  and  some  of  its  therapeutic 
possibilities  are  discussed  in  a  separate  chapter  in  this  sec- 
tion and  with  this  in  mind  special  attention  is  called  to  some 
X-ray  findings  by  Quimby  following  the  use  of  secretin  in 
measured  cases  of  ileac  stasis,  quoted  from  the  New  York 
Medical  Journal,  July  24,  1915. 


SECTION  V.    CHAPTER  23 
THE  MUCINASE  THEORY  IN  MUCOUS  COLITIS 


For  a  long  time  it  was  supposed  that  the  real,  underly- 
ing cause  of  mucous  enterocolitis  was  a  nervous  one,  and 
that  the  neurasthenia  was  intimately  connected  with  the 
causation  of  this  common  and  intractable  condition.  Per- 
sonally I  am  not  convinced  that  this  is  so ;  rather  do  I  believe 
that  the  neurasthenia  so  often  accompanying  mucous  colitis 
is  a  result  of  the  combination  of  conditions — not  a  cause  of 
it. 

About  ten  years  ago  some  very  interesting  work  on  mu- 
cous colitis  was  done  in  France  by  Professor  Roger  and 
his  associates.  Like  many  a  really  good  thing,  the  ocean 
seemed  to  prevent  its  reaching  us  in  this  country,  and 
while  in  all  these  years  "the  mucinase  theory"  has  been  put 
to  practical  use  quite  commonly  abroad,  here  it  is  still  the 
rule  to  muddle  along  with  our  cases  of  mucous  colitis  as  best 
we  can. 

Mucinase  and  the  Coagulation  of  Mucin.  Briefly,  the  idea 
is  this:  The  intestinal  walls  normally  secrete  a  ferment 
named  by  Roger  "mucinase,"  a  function  of  which  is  to 
coagulate  mucin.  This  ferment  is  rendered  inactive  by  cer- 
tain alcohol-soluble,  heat-stable  substances  in  the  bile,  and 
Roger  inferred  that,  since  the  disease  was  so  often  associ- 
ated with  biliary  insufficiency  and  experimentally  produced 
by  diverting  the  bile  flow  from  the  duodenum,  the  membrane 
formation  was  due  to  insufficiency  of  bile.  Later  Riva  ac- 
tually isolated  and  identified  mucinase  in  the  feces  of  pa- 
tients with  this  disorder.  Nepper  and  others  have  proved 
this  both  clinically  and  experimentally,  and  Nepper  has 
come  to  the  conclusion  from  his  clinical  results  that  mucous 
colitis  is  due  to  what  is  called  "oligocholia"  (bile  insuffi- 
ciency) and  cannot  exist  without  it,  and  that  the  membrane 


316  PRACTICAL  ORGANOTHERAPY 

formation  is  due  to  the  abnormal  increase  in  the  ferment 
mucinase  and  to  a  relative  and  simultaneous  diminution  in 
the  production  of  the  bile,  especially  as  regards  its  anti- 
coagulating  power,  which  permits  the  mucinase  secreted 
by  the  intestinal  epithelium  to  assert  its  coagulating  powers. 

All  of  this  explains  the  following  statement  quoted  from 
Roger's  book  on  the  disorders  of  digestion :  "For  those  who 
pass  membranes,  prescribe  an  extract  of  ox-gall,  and  you 
will  frequently  see  a  subsidence  of  the  pain  and  a  complete 
disappearance  of  the  membranous  casts." 

Whether  it  is  true  that  the  bile  plays  an  intimately  im- 
portant role  in  the  causation  of  mucous  colitis,  or  not,  is  a 
matter  of  technical  interest.  We  know  full  well  that  the 
production  of  mucus,  the  resultant  intestinal  irritation  and 
toxemia,  and  the  final  tenesmus  and  discomfort  during  the 
"spells"  of  loosening  the  bacteria-ridden  mucous  poultice 
which  covers  so  much  of  the  intestinal  area,  and  the  general 
malaise  are  always  accompanied  by  symptoms  attributable 
to  hepatic  torpor  and  biliary  insufficiency.  I  do  not  recall 
ever  having  seen  a  case  of  mucous  colitis  where  I  felt  that 
the  production  of  bile  was  normal. 

Many  patients  with  colitis  need  cathartics  during  the 
periods  which  intervene  between  their  "spells,"  and  all  of 
them  are  toxic  and  have  a  very  foul  alimentary  condition. 
If,  instead  of  having  recourse  to  the  usual  cathartic  rem- 
edies, we  would  use  "the  most  natural  cathartic  known"- 
bile — we  might  be  doing  something  of  direct  physiologic 
service  to  the  patient,  for  in  addition  to  its  chologogue  and 
cathartic  value,  the  bile  carries  with  it  a  subtle  something 
that  neutralizes  the  ferment  which  favors  the  coagulation 
of  mucin. 

A  Routine  Method  of  Treatment.  This  is  not  a  theory; 
for  it  has  been  put  to  splendid  use  in  practice  and  I  am  go- 
ing to  suggest  a  routine  method  which  may  stand  many  of 
my  correspondents  in  good  stead  in  some  chronic  case  which 
has  "been  the  rounds"  with  little  or  no  help: 

First  clean  out  the  bowel  by  judicious  catharsis,  a  very 
limited  diet  for  a  day  or  two,  cleansing  enemata — some- 
times a  hypertonic  saline  enema  loosens  the  mucous  nicely 
— and  the  use  of  high  oil  injections  (four  ozs.  of  cottonseed 
oil  preferably,  containing  10  per  cent  of  Isarol)  to  be  re- 
tained all  night  for,  say,  three  nights  in  succession.  Admin- 
ister generous  doses  of  your  favorite  intestinal  antiseptic— 
the  sulphocarbolates,  iodin  in  proper  form,  bismuth  beta- 
napthol  or  salol — and  get  a  decent  start. 


Mucous  COLITIS  317 

Then  prescribe  a  non-toxic  diet  with  the  \easily  putrefi- 
able  proteids  reduced  to  a  minimum  (no  bran,  cellulose  or 
mechanical  irritants)  and  the  known-to-irritate  foods  (all 
these  cases  will  tell  of  some  special  foods  that  cause  unusual 
trouble)  eliminated  entirely. 

Then  give  bile  and  encourage  the  hepato-biliary  function 
to  the  limit.  I  suggest  No.  22,  Bile  Salts  Co.  (Harrow  er) , 
each  dose  of  which  contains  three  grains  each  of  repurified 
powdered  biliary  salts  and  of  desiccated  hepatic  paren- 
chyma. Give  in  stepladder  doses  as  follows:  Prescribe 
one  6-grain  dose  three  times  a  day  between  meals  for  two 
or  three  days,  then  increase  by  adding  an  extra  one  to  the 
last  dose,  then  still  another  dose  until  the  patient  at  the 
end  of  a  couple  of  weeks  is  taking,  perhaps,  three,  three 
times  a  day.  The  signal  to  reduce  the  dosage  is  the  presence 
of  free  bile  accompanying  the  stools,  and  the  patient  should 
be  requested  to  watch  for  the  yellow-green  bile  floating  upon 
the  water  in  the  toilet.  When  this  appears,  irrespective  of 
the  amount  that  is  being  taken  at  that  time,  reduce  the 
dose  to  the  original  one,  three  times  a  day,  and  start  up  the 
ladder  again,  either  at  the  same  rate  (increasing  the  dose 
every  2  or  3  days)  or  at  longer  intervals.  Have  this  pro- 
cedure continued  for  several  months,  or  modify  it  as  sug- 
gested below,  the  while  giving  the  patient  some  acceptable 
form  of  B.  bulgaricus.  (I  have  been  in  the  habit  of  pre- 
scribing a  very  active  and  convenient  fresh  culture  made  by 
the  Vitalait  Laboratory  of  Pasadena — they  send  it  out  twice 
a  week  in  tubes  and  charge  for  it  by  the  month.) 

The  Relation  of  Secretin  to  Mucous  Colitis.  There  is  an- 
other angle  to  the  subject  which  should  be  mentioned. 
While  the  Roger-Nepper  idea  is  sound  and  practical,  it  may 
occur  to  us  to  question  why  there  is  a  biliary  insufficiency, 
with  corresponding  reduction  in  the  production  of  mucin- 
ase,  etc.  There  are  several  fundamental  causes,  one  of  the 
chief  of  which  is  gastric  indigestion  with  deficient  produc- 
tion of  hydrochloric  acid  and  a  consequent  defect  in  the  pro- 
duction of  secretin  in  the  duodenum.  This  is  a  serious  mat- 
ter, for  it  has  been  shown  that  secretin  activates  pancreatic 
digestion,  the  functions  of  the  intestine  itself  and  also  the 
production  of  bile.  Hence  duodenal  extract  (secretin)  may 
be  equally  as  effective  as  bile  salts,  and,  perhaps,  even  more 
fundamental  in  its  influence  than  bile  alone.  It  happens 
that  Secretin  Co.  (Harroiver)  (No.  15)  also  contains  a  dose 
of  bile  salts  as  well  as  an  effective  amount  of  adrenal  sub- 
stance— and  hypoadrenia  is  about  the  most  common  result 


318  PRACTICAL  ORGANOTHERAPY 

of  mucous  colitis  due  to  the  invariable  toxemia  which  natur- 
ally depletes  the  adrenals. 

So  one  has  the  choice  of  these  two  preparations  in  the  or- 
ganotherapeutic  part  of  the  treatment  of  mucous  colitis,  and 
it  is  difficult  to  say  which  is  most  efficacious.  I  recom- 
mend the  Bile  Salts  Co.  in  the  stepladder  method  suggested 
for,  perhaps,  a  month,  and  then  the  continuation  of  the 
treatment  with  Secretin  Co.  for  a  month  or  more.  Both 
may  be  taken  together,  the  dosage  being  regulated  by  the 
effects  of  the  total  amount  of  bile  that  is  given  daily.  The 
fundamentals  of  the  physiology  of  secretin  and  some  re- 
marks about  its  therapeutic  possibilities  will  be  found  in 
Chapter  24  of  this  Section. 


SECTION  V.    CHAPTER  24 
STARLING'S  "ALIMENTARY  HORMONE"— SECRETIN 


In  1902,  Prof.  E.  H.  Starling,  of  University  College,  Lon- 
don, announced  the  discovery  of  what  has  been  called  "the 
original  hormone."  He  named  it  secretin  and  established 
the  fact  that  its  essential  function  was  to  activate  the  pan- 
creatic enzyme  precursors.  It  appears  that  this  was  the 
first  internal  secretory  product  to  be  studied  in  an  accurate 
manner,  and  Starling  coined  the  term  "hormone"  (from  the 
Greek,  "I  arouse,  or  set  in  motion")  to  designate  the  class 
of  "chemical  messengers"  of  which  the  newly  discovered 
secretin  was  the  type. 

The  Origin  of  Secretin.  Secretin  is  produced  in  the  cells 
of  the  duodenal  mucosa,  and,  unlike  the  duodenal  secretion, 
is  passed  into  the  blood  rather  than  into  the  alimentary 
canal,  and  by  humoral  passages  reaches  the  pancreatic  cells 
and  there  combines  with  protrypsinogen  and  other  half- 
formed  enzymes.  The  secretin  becomes  an  actual  part  of 
the  finished  cell  product.  It  is  a  true  hormone,  and  in  the 
past  eighteen  years  has  been  shown  to  have  a  much  larger 
range  of  physiological  activity,  as  well  as  to  be  an  agent  of 
considerable  therapeutic  merit  in  furthering  deficient  func- 
tions of  the  character  that  this  hormone  is  known  to  acti- 
vate. 

Much  criticism  fell  upon  Starling  and  his  co-workers,  es- 
pecially by  the  Russian  school  headed  by  Popielski,  who  felt 


THE  ALIMENTARY  HORMONE  319 

that  the  grandeur  of  the  then  recent  work  of  Pavloff  on  the 
"appetite  reflex"  had  been  unwarrantably  dimmed.  As  a 
matter  of  fact,  Popielski  failed  to  show  that  there  were  any 
nervous  impressions  involved  in  the  hormonic  effects  of  se- 
cretin,  and  some  years  later  Hustin,  of  Brussels,  clinched  the 
matter  beyond  all  peradventure  by  activating  the  production 
of  pancreatic  juice  by  a  canine  pancreas  lying  in  a  paraffin 
bath,  the  dog  having  been  destroyed  previously.  I,  myself, 
know  of  this  beyond  doubt,  for  I  had  a  chance  to  work  with 
Hustin  in  his  laboratory  at  the  Institut  Pare  Leopold,  while 
a  method  of  proving  the  activity  of  secretin  on  the  isolated 
pancreas  was  being  developed. 

Hallion  and  Enriquez,  of  Paris,  showed  conclusively  that 
secretin-bearing  extracts  from  duodenum  stimulated  the 
duodenum  itself  to  greater  secretin  production,  as  well  as 
its  other  functions.  The  administration  of  secretin  causes 
an  increased  blood  supply  to  the  duodenal  mucosa  and  ac- 
tually increases  the  secretin  content  of  the  cells  by  test. 

The  Therapeutic  Value  of  Secretin.  Still  later,  Beveridge, 
of  New  York,  showed  that  secretin  exerted  a  subtle  in- 
fluence, direct  or  indirect,  upon  the  protein-digesting  capac- 
ity of  the  blood  cells,  and  emphasized  the  value  of  secretin- 
bearing  extracts  when  given  by  mouth.  Secretin  has  since 
been  found  to  have  an  extended  influence  upon  alimentary 
functions  as  a  whole  and  particularly  upon  the  liver.  It  was 
proved  that  duodenal  extracts  exert  a  chologogue  influence 
equally  with  bile,  but  in  a  different  manner.  Perhaps  the 
most  recent  work  on  this  subject  is  that  of  Eddy,  of  Mon- 
treal (Am.  Jour.  PhysioL,  March,  1919).  He  and  Downs 
conclude  that  "the  amount  of  bile  is  increased  by  secretin." 

The  subject  was  fully  outlined  by  me  in  a  paper  published 
in  the  New  York  Medical  Journal  as  far  back  as  August, 
1913,  and  considerable  interest  in  the  possibilities  of  this 
remedy  was  aroused.  This  article  was  considered  of  suffi- 
cient importance  to  be  translated  into  German  by  Professor 
Boas,  and  published  in  his  Archiv  fur  Verdauungs-Krank- 
heiten.  In  this  paper,  the  following  conclusions  were  made : 

(1)  Secretin  is  a  specific  excitant  of  all  of  the  important 
digestive  juices — pancreatic,  gastric,  hepatic  and  intestinal. 

(2)  It  may  be  given  by  mouth  with  good  results  in  the 
large  class  of  gastro-hepato-intestinal  disorders  described 
under  the  general  head  of  "digestive  insufficiencies." 

(3)  Such  medication  is  absolutely  physiological,  as  in 
certain  cases  it  seems  that  secretin  is.  a  necessary  substance 
which  the  bodj  is  not  supplying  in  its  normal  amount. 


320  PRACTICAL  ORGANOTHERAPY 

(4)  Secretin  is  not  a  digestant,  having  no  influence  what- 
ever comparable  to  the  commonly  used  ferments,  pepsin  or 
pancreatin. 

This  work  has  been  the  subject  of  considerable  criticism, 
and  some  experimentalists  have  shown  conclusively  (upon 
normal  or  anesthetized  dogs,  rather  than  by  clinical  tests  on 
patients  with  alimentary  insufficiencies)  that  secretin  by 
mouth  is  inactive  and  that  dry  extracts  of  the  duodenal 
mucosa,  such  as  are  used  in  medicine  today,  do  not  contain 
secretin.  Yet  for  nearly  ten  years  physicians  in  France, 
Italy,  England  and  the  United  States  have  continued  the  use 
of  duodenal  preparations  with  what  they  have  believed  to 
be  good  results — results  which  have  shown  themselves 
superior  to  those  following  other  methods  of  controlling  di- 
gestive deficiencies,  especially  in  chronic  cases  where  other 
measures  have  been  tried  fruitlessly. 

Influence  of  Secretin  on  Nutrition.  In  discussing  the  thera- 
peutic possibilities  of  secretin,  Kingsley  (N.  Y.  Med.  Jour., 
July  24,  1915)  called  attention  to  the  fact  that  many  at- 
tempts had  been  made  to  use  secretin  in  diabetes  because 
its  characteristic  action  on  the  pancreas  was  supposed  to 
extend  beyond  its  well-known  enzyme-stimulating  effects 
and  to  increase  the  internal  secretory  powers  of  this  gland. 
It  has  been  used  in  a  number  of  cases  of  diabetes,  but  almost 
universally  had  no  effect  upon  the  sugar  in  the  urine.  On 
the  other  hand,  diabetics  using  it  gained  in  weight  from 
10  to  20  pounds  and  were  greatly  improved  in  general  health. 
It  was  hard  to  reconcile  these  two  observations,  and  an  ex- 
planation of  the  good  results  is  found  in  Beveridge's  paper, 
which  was  under  discussion,  which  tells  of  the  favorable 
action  of  secretin  on  protein  metabolism  and  in  relieving 
intestinal  stasis  and  the  accompanying  toxemia. 

The  Physiology  of  Digestion.  A  word  or  two  about  the 
physiology  of  secretin  in  digestion  will  be  helpful  in  estab- 
lishing the  importance  of  duodenal  preparations  in  thera- 
peutic practice.  It  is  proved  that  the  acid  chyme  (or  HC1) 
passing  from  the  stomach  is  the  key  which  unlocks  the  duo- 
denal cells  and  liberates  the  secretin.  If  there  is  achlorhyd- 
ria,  obviously  there  is  little  or  no  secretin,  and  consequently 
pancreatic  indigestion  ensues,  with  its  typical  intestinal  find- 
ings. If  acid,  (lactic,  hydrochloric  or  even  tartaric)  is 
administered  to  such  cases  in  a  capsule  which  is  insoluble  in 
the  stomach,  the  solution  of  this  acid  in  the  upper  intestine 
will  partially  take  the  place  of  the  missing  gastric  acid  and 
release  some  secretin,  at  least.  In  all  cases  of  gastric  in- 


THE  ALIMENTARY  HORMONE  321 

sufficiency — achylia,  hypopepsia,  cancer  (local  or  general) 
and  "gastric  asthenia" — the  urge  to  liberate  secretin  and 
thereby  activate  the  whole  digestive  cycle  is  reduced  or 
missing. 

Secretin  is  a  stable,  chemical  substance  which  is  evidently 
not  entirely  destroyed  by  the  digestive  ferments  or  acids, 
despite  a  few  statements  in  the  literature,  hence  to  give  it 
is  to  "set  in  motion"  a  chain  of  physiological  circumstances 
of  equal  importance  and  comparatively  similar  to  the  admin- 
istration of  thyroid  extracts  in  hypothyroidism  or  any  other 
form  of  homo-stimulative  organotherapy.  Carlson,  of  Chi- 
cago, denies  the  efficacy  of  secretin  in  therapeutics,  and 
derides  me  for  my  opinions;  yet  since  his  paper  was  pub- 
lished I  have  used  secretin  products  for  years  and  cannot 
disbelieve  my  own  experiences  nor  deny  repeated  statements 
made  to  me  by  other  practicing  physicians.  One  of  these,  a 
famous  gastro-enterologist,  whose  book  is  well  known,  told 
me  personally,  after  publication  of  the  paper,  herein  men- 
tioned, with  its  hard  and  fast  conclusions  that  my  state- 
ments and  those  of  others  "ran  contrary  to  well-established 
experimental  facts,"  that  he  had  practiced  his  specialty  for 
over  twenty-five  years,  and  that  he  had  never  found  as  ac- 
tive digestive  stimulants  as  the  secretin  preparations — he 
had  used  two  kinds — and  that  he  spoke  from  personal  as 
well  as  from  clinical  experiences.  I  prefer  to  believe  a  prac- 
tical clinician  in  anything  of  this  character. 

Clinical  Reports  in  the  Literature.  There  are  a  number 
of  statements  in  the  literature  (and,  by  this  time,  in  several 
of  the  text  books)  speaking  favorably  of  the  therapeutic 
value  of  duodenal  extracts  and  secretin.  Beveridge  sum- 
marizes his  clinical  findings  (N.  Y.  Med.  Jour.,  June  26, 
1915)  as  follows:  (1)  Secretin  is  indicated  in  all  pancreatic 
insufficiencies  where  true  organic  changes  have  not  occurred. 
(2)  It  may  be  employed  to  advantage  in  aiding  protein  di- 
gestion. (3)  It  is  a  most  important  factor  in  raising  a  low 
urea  output  to  normal.  (4)  It  is  indicated  in  gastroenteros- 
tomy  and  jejunostomy.  (5)  It  is  of  distinct  value  in  ne- 
phritis of  intestinal  origin.  (6)  It  increases  peristalsis  and 
is  indicated  in  all  cases  of  stasis. 

A.  J.  Quimby  examined  a  number  of  Beveridge's  patients 
with  the  X-ray  and  stated  that  the  impressions  of  the  value 
of  this  measure  were  gratifying.  In  some  of  the  worst 
types  of  stasis,  practically  no  iliac  stasis  existed  and  the 
colon  delay  was  materially  reduced.  He  remarked  that 
"having  followed  With  interest  the  progress  of  the  several 

21 


322  PRACTICAL  ORGANOTHERAPY 

patients  who  were  examined  by  the  X-ray  during  their 
treatment  with  secretin,  he  had  been  pleased  and  astonished 
at  the  remarkable  improvement"  (N.  Y.  Med.  Jour.,  July 
24,  1915,  p.  217). 

In  the  same  discussion,  W.  E.  Fitch  said  that  notwith- 
standing the  contention  of  some  authorities  to  the  contrary, 
his  personal  experience  had  completely  convinced  him  that 
secretin  was  a  potent  remedy  when  administered  by  the 
mouth.  For  about  a  year  he  had  suffered  from  intestinal 
stasis,  and  the  symptoms  had  been  completely  relieved  by 
its  use.  When  he  stopped  taking  it  he  found  that  the  symp- 
toms returned,  but,  after  taking  it  again  for  several  days, 
these  entirely  disappeared.  From  his  own  experience,  there- 
fore, as  well  as  from  his  observation  of  its  effects  on  others, 
he  "was  an  enthusiast  for  secretin." 

With  these  reports,  old  and  new,  experimental  and  clin- 
ical, in  mind,  what  shall  we  say  then  about  the  availability 
of  duodenal  extract  in  gastro-intestinal  secretory  insuffi- 
ciencies, with  their  numerous  baneful  results?  I  say  this: 
Secretin,  i.  e.,  suitably  prepared  desiccated  duodenal  scrap- 
ings, is  well  worth  a  trial,  for  it  has  served  well  heretofore 
and  it  may  again! 

Reinforcing  Duodenal  Extracts.  The  desiccated  duodenal 
extract  may  be  combined  with  a  useful  dose  of  active  bile 
salts  which  admittedly  stimulate  biliary  secretion,  and  hence 
are  likely  to  be  of  reinforcing  value  in  practically  all  forms 
of  alimentary  insufficiency  for  which  secretin  has  been 
recommended.  Further,  since  the  adrenal  glands  play  such 
an  important  part  in  the  regulation  of  alimentary  tone,  both 
muscular  and  secretory,  and  some  prominent  French  phy- 
sicians have  gone  so  far  as  to  classify  a  definite  form  of  in- 
digestion as  "adrenal  dyspepsia"  and  recommend  adrenal 
therapy  for  it,  the  addition  of  a  suitable  amount  of  adrenal 
substance  is  in  order,  the  more  especially  as  chronic  diges- 
tive troubles  are  commonly  accompanied  by  hypoadrenia 
with  its  cardinal  symptoms  of  asthenia,  hypotension  and  de- 
ficient oxidation. 

Usual  Indications.  To  conclude,  I  recommend  Secretin 
Co.  (Harroiver)  (No.  15)  as  an  adjunct  to  the  usual  elimin- 
ative,  dietetic  and  hygienic  treatment  of  alimentary  insuffi- 
ficiency,  which  manifest  themselves  as  dyspepsia;  gastro- 
intestinal fermentation  and  putrefaction;  hepato-biliary, 
pancreatic  and  intestinal  indigestion;  constipation;  stasis 
and  chronic  malnutrition  of  digestive  origin.  The  dosage  is 
somewhat  indefinite.  In  most  cases,  two  doses  between 


REMINERALIZATION  323 

meals  suffice,  and  this  is  recommended  to  beg-in  with.  After 
two  or  three  weeks,  it  may  be  reduced.  Occasionally  still 
larger  doses  may  be  used  for  a  short  time.  It  must  be  re- 
membered that  this  is  not  a  ferment  preparation  and  its 
ingredients  do  not  act  locally  upon  the  mucous  membrane 
of  the  digestive  tract  and  that  its  principal  function  is  to 
facilitate  the  reestablishment  of  a  deficient  secretory  func- 
tion just  as  we  expect  glandular  stimulation  from  any  other 
phase  of  organotherapy.  In  whatever  dose  it  may  be  given, 
it  should  be  remembered  that  associated  treatment  is  indi- 
cated, i.  e.,  that  Secretin  Co.  does  not  take  the  place  of  diet- 
etic regulation,  alkalinization,  the  removal  of  accumulated 
alimentary  wastes,  etc.,  and  further,  that  the  effect  of  this, 
as  of  other  forms  of  organotherapy,  is  of  a  reeducative 
character,  hence  should  be  continued  for  some  time. 


SECTION  V.    CHAPTER  25 

THE  MINERAL  SALTS  IN  HEALTH  AND  DISEASE: 
REMINERALIZATION 


The  metabolism  of  the  mineral  salts  is  at  once  one  of  the 
most  difficult  puzzles  and  one  of  the  most  fascinating  studies 
in  human  physiology,  and  has  been  the  subject  of  much  dis- 
cussion for  many  years. 

The  mineral  part  of  the  body,  as  of  the  food,  is  fully  as 
important  in  the  nutritive  process  as  the  other  better-known 
elements.  The  minerals  used  by  the  body  are  by  no  means 
merely  concerned  in  maintaining  the  cell  structure,  espe- 
cially of  the  bones,  but  investigation  of  the  methods  whereby 
the  body  renews  itself  and  antagonizes  the  toxemia  of 
health  and  disease  discloses  a  phase  of  mineral  metabolism 
represented  by  a  continued  struggle  between  acids  and  al- 
kalies. "Acidity  spells  death — alkalinity  life,"  for  after 
death  the  alkaline  reaction  of  the  blood  and  body  fluids  is 
lost,  while  on  the  other  hand  alkalies  very  often  serve  to 
stave  off  the  tendency  to  acidemia,  which  is  one  of  the  grim 
reaper's  most  effective  weapons. 

Crystalloids  and  Colloids.  The  essential  role  of  the  inor- 
ganic elements  of  the  body  is  not  fully  understood,  and  much 
discussion  has  centered  around  the  "crystalloids" — salts  of 
an  inorganic  and  non-physiologic  character  which  pass  rap- 
idly through  membranes  and  therefore  are  not  easily  re- 


324  PRACTICAL  ORGANOTHERAPY 

tained  by  the  body — and  the  "colloids" — mineral  salts  which 
have  been  so  changed  that  they  have  acquired  an  organic 
character  and  are  not  now  crystalline  but  semigelatinous 
and  diffusible.  It  appears  that  the  normal  salts  in  solution 
in  the  fluids  of  the  body  are  identical  chemically  with  simi- 
lar inorganic  salts  of  like  molecular  makeup,  yet  physi- 
cally they  are  different,  the  permeability  just  mentioned 
causing  a  difference  which  enables  the  body  to  use  and  re- 
tain colloidal  salts  without  their  being  carried  off  by  the 
emunctories,  while  the  crystalline  salts  are  speedily  dis- 
solved and  eliminated.  How  the  crystalloids  metamorphose 
into  colloids,  and  what  the  difference  is  between,  say,  the 
potash  salts  in  vegetables  and  potash  dug  out  of  the  earth, 
is  not  known. 

It  may  be  of  interest  to  recall,  in  this  connection,  that 
spleen,  which  is  a  hematinic,  is  supposed  to  exert  a  "colloido- 
genic"  action,  i.  e.,  it  favors  the  maintenance  of  the  mineral 
salts  of  the  body  in  their  colloid,  organic  state  and  thus  pre- 
vents this  so-called  "demineralization" ;  and,  to  mention  only 
one  other  point  in  this  brief  statement,  according  to  Schiff, 
this  organ  (and  extracts  of  it)  favor  the  "fixing"  of  iron 
by  the  cell. 

In  certain  diseases  there  develops  a  tendency  toward  min- 
eral starvation — "demineralization,"  as  the  French  call  it — 
and  in  tuberculosis,  perhaps  the  best  understood  of  these, 
Robin  has  shown  that  the  tissues  seriously  lack  these  min- 
erals, lime,  phosphates,  etc.)  and  also  that  the  urinary  out- 
put of  these  substances  is  greater  than  urinal.  Endocrine 
dysfunction  favors  mineral  deficiency  because  of  the  slowed 
and  disturbed  chemistry  resulting  from  the  lessened  hor- 
mone stimuli  which  are  necessary  to  maintain  metabolism 
at  its  proper  speed.  The  wastes  which  are  not  fully  oxidized 
are  many  of  them  of  acid  nature  and  neutralize  the  body's 
reserve  of  alkalies,  and  bring  about  the  condition  known 
as  "demineralization."  Just  as  soon  as  there  is  a  deficiency 
in  this  alkaline  mineral  reserve  a  further  improper 
functioning  of  the  ductless  glands  is  favored.  In  some  in- 
stances they  may  be  irritated  by  these  poisons,  but  in  most 
cases  their  function  is  lessened — they  are  overburdened.  It 
is  difficult  to  determine  just  when  cause  becomes  effct,  and 
vice  versa;  but  insufficient  activity  of  the  endocrine  glands 
and  demineralization,  or  a  lessening  of  the  body's  reserve 
of  alkaline  salts,  are  intimately  related  to  one  another,  and 
from  a  clinical  standpoint,  should  be  considered  simultan- 
eously. In  certain  endocrine  disorders  (of  the  ovaries,  para- 


KEMINERALIZATION  325 

thyroids  and  thymus,  to  mention  those  most  studied  and 
discussed  in  the  literature)  serious  changes  in  the  mineral 
metabolism  result,  and  the  administration  of  certain  salts, 
notably  of  calcium,  may  be  of  noteworthy  therapeutic 
benefit. 

Bayle,  of  Cannes  (Revue  de  Med.,  Paris,  1911,  xxxi,  p. 
482),  believes  that  the  spleen  has  a  "colloidogenic"  func- 
tion— that  of  transforming  easily  lost  crystalline  salts  into 
colloids  which  can  be  retained,  and  the  prevention  of  a 
pathological  change  of  the  colloids  with  their  subsequent 
automatic  loss  to  the  organism.  He  has  given  spleen  extract 
on  this  basis  and  asserts,  from  the  nutritional  standpoint 
as  well  as  from  laboratory  experiments,  that  whether  his 
"colloidogenic  theory"  is  sound  or  not,  it  works  in  practice. 

The  Importance  of  the  Alkaline  Reserve.  Much  contro- 
versy has  developed  over  the  question  of  the  availability  of 
the  mineral  organic  salts  so  often  prescribed,  and,  as  usual, 
certain  laboratorians  seem  to  deny  the  right  of  the  clini- 
cians to  draw  their  conclusions.  While  the  opinions  still  dif- 
fer exceedingly  as  to  the  acceptability  of  these  salts  by  the 
body,  clinical  experience  indicates  several  important  points 
which  may  be  reiterated  here : 

First,  the  normal  and  abnormal  wastes  of  the  organism 
are  either  actual  acids  (such  as  lactic,  carnic,  indol-acetic, 
oxybutyric,  etc.)  or  of  an  acid  nature  (as  indican  or  potas- 
sium indoxyl-sulphonate) — and  they  combine  with  and  neu- 
tralize the  alkalies  of  the  blood  and  tissues.  They  are  "alkali 
robbers"  and  seem  to  make  no  distinction  between  the  alka- 
lies, whether  colloid  or  crystalloid.  It  is  well  known  that 
a  certain  reserve  of  alkaline  salts  is  necessary  to  normal 
physiology  and  that  among  many  functions  which  might 
be  mentioned,  the  oxygen  and  carbon  dioxide  exchange  car- 
ried on  through  the  hemoglobin  molecules  of  the  red  blood 
cells  is  only  accomplished  effectively  in  the  presence  of  an 
optimal  amount  of  alkali  in  the  blood.  Decrease  this  reserve, 
and  oxidation  becomes  materially  reduced,  more  wastes  are 
produced  throughout  the  body,  and  a  vicious  circle  is  imme- 
diately formed. 

The  Frequency  of  Acidosis.  The  body  is  continually  fight- 
ing acids.  Acidosis  and  acidemia  are  conditions  which  may 
ensue  at  any  time  that  the  alkali  reserve  is  too  greatly  de- 
pleted, and,  unfortunately,  the  tendency  is  gradually 
towards  acidosis,  for  "man  begins  to  die  as  soon  as  he  is 
born."  Ordinarily  the  balance  is  well  maintained  in  health, 
though  the  tendencies  of  eating,  breathing  and  living  in  our 


326  PRACTICAL  ORGANOTHERAPY 

"foolish  civilization"  are  decidedly  in  favor  of  the  acid  state. 
We  eat  large  quantities  of  acid-containing  and  acid-produc- 
ing foods,  especially  the  meats;  we  cook  our  vegetables  in 
such  a  manner  that  the  salts  are  lost;  we  throw  away  the 
best  mineral-containing  portions  of  the  cereals  in  our  bread, 
and  our  methods  of  breathing  and  daily  hygiene,  all  the  time, 
favor  the  depletion  of  the  all-important  alkaline  mineral 
reserve.  In  a  study  of  scurvy  (Jour.  Biol.  Chem.,  Baltimore, 
1918,xxxvi,  p.  439),  Pitz  reports  a  number  of  experiments 
on  the  influence  of  meat  and  various  salts  upon  the  develop- 
ment of  this  serious  nutritive  disorder,  and  in  his  summary 
he  remarks  that  "these  experiments  point  to  a  little-empha- 
sized role  of  the  calcium  salts  in  nutrition,  namely,  that  of 
controlling  the  permeability  of  various  animal  tissues  and 
thereby  affording  protection  against  invading  agents."  In 
this  connection,  some  recent  conclusions  of  Bulman,  a  Mex- 
ican physician  (Gaceta  Acad.  Med.,  Mexico,  June,  1917), 
based  upon  the  study  of  lime  in  physiology  and  therapeutics, 
are  very  interesting.  The  Indians  in  Mexico  are  noted  for 
the  preservation  of  their  teeth,  even  in  individuals  of  ad- 
vanced age.  As  soon  as  they  become  "civilized"  and  change 
their  dietetic  habits,  they  develop  caries,  which  is  explained 
by  Bulman  by  the  loss  of  the  phosphates  and  other  salts 
found  in  the  outer  part  of  the  grain,  which  are  lost  by  the 
fine  bolting  of  the  flour.  These  are  needed  to  keep  the  teeth 
strong,  especially  during  pregnancy.  This  lack  of  earthy 
phosphates  may  result  in  disease  or  loss  of  the  teeth.  Inci- 
dentally, Bulman  advises  the  addition  of  these  salts  to  the 
food,  especially  during  pregnancy  and  lactation,  and  tells 
of  one  sick  mother  taking  them  and  rickets  in  her  child  dis- 
appearing under  it.  The  "deficiency  diseases,"  so  called, 
are  not  by  any  means  due  to  lack  of  vitamines  alone,  but 
involve  the  whole  of  this  question  of  demineralization  and 
remineralization. 

We  know  how  common  acidosis  is,  or,  as  we  may  now  call 
it,  demineralization.  It  is  a  serious  outcome  of  diabetes  and 
nephritis.  It  very  commonly  follows  anesthesia,  much  re- 
search in  the  last  few  years  indicating  that  the  capacity  of 
the  plasma  for  combining  with  carbon  dioxide  is  decreased 
by  anesthesia;  in  other  words,  anesthesia  depletes  the  al- 
kaline reserve.  As  a  result  of  this,  a  generous  administra- 
tion of  alkali  prior  to  surgical  operations  prevents  this  de- 
pletion, increases  the  factor  of  safety,  and  almost  entirely 
eliminates  post-operative  vomiting — a  condition  which  we 
now  know  to  be  due  really  to  demineralization.  Certain 


REMINERALIZATION  327 

metabolic  disorders  of  children,  notably  rickets,  epilepsy, 
chorea  and  general  malnutrition,  are  related  so  intimately 
to  this  mineral  deficiency  that  cases  of  all  these  conditions 
are  on  record  as  having  been  entirely  cured  by  reestablishing 
the  mineral  balance.  All  of  the  chronic  toxemias,  including 
intestinal  stasis,  rheumatism,  neurasthenia  and  tuberculosis, 
to  mention  a  few,  have  a  very  large  factor  of  this  character ; 
and  alkaline  depletion,  demineralization,  lime  starvation,  or 
acidosis  (as  this  condition  is  variously  called),  are  always 
important  factors  thereof,  and  evidently  conditions  which 
can  be  readily  modified. 

The  Influence  on  the  Endocrines.  Finally,  mineral  metab- 
olism is  intimately  connected  with  disturbances  of  function 
of  the  glands  of  internal  secretion.  Not  merely  does  dys- 
function of  certain  glands  seem  to  cause  serious  changes  in 
the  mineral  balance,  but  since  these  glands  as  a  whole  main- 
tain the  tonicity,  metabolism  and  general  cellular  activity  of 
the  body,  insufficient  endocrine  function  must  necessarily 
mean  a  serious  change  in  the  alkali  reserve.  As  a  matter 
of  fact,  this  phase  of  the  subject  has  interested  me  un- 
usually, for  one  of  the  most  common  associated  findings  in 
endocrine  disease  is  demineralization.  Dyscrinism — de- 
ranged endocrine  activity — and  demineralization — depletion 
of  the  alkaline  reserve  of  the  body — always  go  together. 
When  one  is  obvious,  look  for  the  other.  When  organo- 
therapy is  indicated  as  a  means  of  modifying  disturbed  en- 
docrine activity,  remineralization  is  distinctly  in  order.  Take 
as  an  example  the  condition  of  hypothyroidism,  one  of  the 
most  frequent  internal  secretory  disturbances.  The  first 
function  of  the  thyroid  is  to  stimulate  oxidation,  and  the 
first  result  of  thyroid  insufficiency  is  deficient  cell  chemistry, 
poor  oxidation  and  infiltration  by  the  accumulated  wastes 
of  the  organism.  Since  these  wastes  are  of  an  acid  nature, 
we  would  expect  the  alkali  reserve  of  the  body  to  be  de- 
pleted, and  this  is  indeed  the  case;  hence  every  case  legiti- 
mately in  need  of  thyroid  extract  is  suffering  from  mineral 
starvation.  To  recapitulate:  hypothyroidism  means  sub- 
oxidation;  suboxidation  means  toxemia;  toxemia  means 
acidemia;  acidemia  means  alkaline  neutralization  or  demin- 
eralization. 

Just  as  sure  as  the  chemistry  of  the  body  is  disturbed, 
either  by  the  administration  of  an  abnormal  amount  of  tox- 
ins or  by  the  production  of  an  abnormal  amount  of  waste 
products,  so  sure  does  this  matter  of  demineralization  and 
remineralization  enter  into  the  case,  and  I  have  yet  to  see  an 


328  PRACTICAL  ORGANOTHERAPY 

endocrine  case  in  which  this  principle  was  not  prominently 
involved. 

Practical  Therapeutic  Application.  What  is  the  thera- 
peutic value  of  all  this  ?  Is  it  possible  to  remineralize  by  the 
simple  use  of  inorganic  crystalloid  salts  which  the  organism 
is  not  supposed  to  be  capable  of  "fixing"  or  changing  to  the 
colloid  state,  especially  in  disease  as  a  result  of  which  it  fails 
to  retain  its  own  essential  mineral  elements  ?  This  is  a  diffi- 
cult question  to  answer  in  a  scientific  manner,  but  clinically 
it  is  easy.  While  it  may  be  easier  to  prevent  demineraliza- 
tion  than  to  cause  remineralization,  there  can  be  no  doubt 
that  the  administration  of  suitable  quantities  of  selected 
mineral  salts  is  helpful  in  several  ways:  (1)  They  neutral- 
ize excesses  of  acid  wastes  and  "one  cannot  bring  about  re- 
mineralization  if  there  exists  in  the  organism  a  permanent 
building  up  of  acids."  (2)  They  thereby  spare  the  organism, 
or  the  colloid  minerals  already  in  the  body  or  the  food  in- 
gested, for  whether  colloid  or  crystalloid,  these  alkaline  salts 
immediately  and  inevitably  must  combine  with  these,  acids. 
(3)  They  indirectly  favor  the  work  of  the  detoxicating 
mechanism  of  the  body,  especially  that  of  the  ductless 
glands,  by  the  restoration  of  the  alkali  reserves  just  men- 
tioned. (4)  They  may  indeed  be  transformed  and  thereby 
suited  to  be  stored  as  the  body's  reserve  through  the  col- 
loidogenic  function  claimed  by  Bayle  to  lie  in  the  spleen,  as 
already  mentioned.  (Progres  Med.,  Paris,  1913,  xxix, 
p.  530.) 

At  all  events,  the  administration  of  "inert"  organic  min- 
eral salts  is  not  without  obvious  clinical  benefit,  whether  we 
can  answer  the  question  as  to  how  this  is  accomplished  or 
not.  The  correction  of  this  ultimate  condition  is  just  as 
rational  as  the  augmentation  of  the  endocrine  deficiency 
which  may  have  caused  it.  Remineralization  should  be  the 
rule  in  all  chronic  diseases,  especially  those  which  involve 
metabolism  and  nutrition.  Several  methods  are  available. 
It  is  very  easy  to  recommend  a  package  of  "Arm  and  Ham- 
mer" brand  and  to  suggest  60  to  100  grains  a  day  in  plenty 
of  water,  remote  from  meals.  As  a  matter  of  fact,  half  a 
dozen  generous  doses  of  soda  bicarbonate  with  plenty  of 
water  is  now  a  routine  preparatory  measure  in  many  surgi- 
cal clinics.  In  France,  they  use  bone  dust,  oyster-shell  pow- 
der and  other  "organotherapeutic"  mineral  preparations. 
I  do  not  believe  that  these  salts  are  any  more  easily  assimi- 
lated than  the  ordinary  chemicals  of  commerce.  For  in- 
stance, dibasic  calcium  phosphate  is  actually  made  from 


REMINERALIZATION  329 

bone,  and  therefore,  according  to  some  should  really  be 
called  an  "organic  mineral"  salt. 

A  Remineralizing  Formica.  For  some  time  I  have  used 
and  recommended  a  mixture  of  salts  which  are  combined  in 
proportions  quite  similar  to  those  in  the  blood.  This  com- 
bination of  salts  is  as  follows:  Magnesium  phosphate,  1; 
diabasic  calcium  phosphate,  4 ;  calcium  glycerophosphate,  4 ; 
potassium  bicarbonate,  16 ;  sodium  bicarbonate,  25 ;  and  sod- 
ium chloride  to  make  100  parts.  These  correspond  quite 
closely  to  those  found  in  the  blood,  though  the  more  stren- 
uous sodium  carbonate  is  replaced  by  the  bicarbonate,  which 
is  not  so  irritable,  nor  is  it  so  deliquescent.  This  combina- 
tion, under  the  name  Calcium-Phosphorus  Co.  (Harrower), 
is  the  standard  diluent  in  The  Harrower  Laboratory,  taking 
the  place  of  the  usual  milk  sugar,  because  it  has  a  distinct 
therapeutic  value,  especially  in  cases  where  it  may  be  ad- 
visable to  use  organotherapy. 

To  satisfy  a  demand  which  has  developed  quite  naturally, 
I  have  had  prepared  for  us  a  tablet  consisting  of  the  above 
formula  without  sodium  chloride  and  sold  under  the  name 
Calcium-Phosphorus  Co.,  each  containing  one  gram 
(ISVii  grains) ;  so  these  salts  are  now  obtainable  in  con- 
venient form,  and  offer  an  effective  method  of  remineraliza- 
tion.  Under  ordinary  circumstances,  to  an  adult  one  should 
prescribe  three  tablets,  crushed,  with  much  water  (2  glasses 
is  preferable) ,  an  hour  before  food,  twice  a  day  for  three  or 
four  weeks,  and  thereafter  on  alternate  weeks.  Obviously, 
such  salts  should  not  be  taken  on  a  full  stomach,  for  the 
gastric  acidity  would  be  partially  neutralized  and  the  effec- 
tiveness of  the  alkalies  immediately  lost.  Two  doses  are 
more  convenient  than  three,  and  fully  as  satisfactory,  be- 
cause of  the  difficulty  of  fitting  them  into  the  daily  routine. 
Such  dosage  should  be  continued  for  several  weeks  and 
later  renewed  for  a  week  or  so  each  month. 

Conclusions.  To  recapitulate :  I  firmly  believe  that  a  con- 
certed effort  needs  to  be  made  to  study  the  mineral  balance 
and  reestablish  it,  just  as  I  have  long  since  urged  the  study 
and  regulation  of  the  hormone  balance.  This  is  best  accom- 
plished as  follows: 

(1)  Restore   endocrine   activity,  i.  e.,  support   depleted 
adrenals;  replace  the  missing  thyroid  secretion,  etc.,  by 
organotherapy. 

(2)  Proscribe  all  foods  which  tend  to  produce  acids. 
These  need  not  be  named,  to  save  time  and  controversy! 

(3)  Prevent    alimentary    stasis    and    toxemia,    for    the 


330  PRACTICAL  ORGANOTHERAPY 

products  of  intestinal  putrefaction  are  the  most  prolific 
sources  of  alkali  starvation. 

(4)  Increase  the  general  me.tabolism  by  exercise,  water 
drinking  and  hygiene,  thereby  preventing  the  accumulation 
of  intracellular  wastes  which,  like  all  such  metabolites,  are 
bound  to  "steal"  a  certain  amount  of  the  precious  reserve. 

(5)  Impress  the  importance  of  the  alkaline  value  of  vege- 
tables and  the  acid  value  of  meats.    Potatoes  are  as  rich  in 
potassium  salts  as  any  available  food.    Remember  that  the 
usual  methods  of  cooking  dissolve  out  these  very  salts— 
therefore  baked  or  steamed  potatoes  are  far  superior  to 
boiled.    Remember,  too,  that  the  absurd  notions  about  the 
looks  of  flour  and  bread  have  developed  a  custom  of  remov- 
ing from  wheat  a  large  portion  of  the  salts  which  the  Crea- 
tor intended  to  be  used  and  which  are  found  in  whole  wheat 
and  whole  grain  preparations. 

(6)  Administer  suitable  quantities  of  the  salts  which 
correspond  to  those  present  in  the  blood — preferably,  from 
my  personal  standpoint,  Calcium-Phosphorus  Co. 

What  results  can  be  expected  from  the  association  of  the 
remineralizing  process  with  other  indicated  treatment? 
Just  these :  That  oxidation  is  increased,  the  elimination  im- 
proved and  the  well-being  very  decidedly  benefited.  It  seems 
superfluous  to  need  to  tell  what  kind  of  results  may  be  ex- 
pected, for  if  a  person  is  demineralized,  he  needs  remin- 
eralization  just  as  a  starving  person  needs  food;  and  these 
minerals  are  indeed  foods  and  not  drugs.  This  routine  in 
our  study  and  treatment  of  cellular  laziness  and  toxemia 
is  but  one  single  factor.  To  remedy  it  is  but  a  part  of  the 
treatment,  but  it  is  indeed  a  very  important  part. 


SECTION  V.     CHAPTER  26 
RENAL  THERAPY  IN  NEPHRITIS 


Bright's  disease  and  other  forms  of  nephritis  usually  give 
us  the  impression  that  they  can  only  be  modified  by  the 
simple  measures  intended  to  spare  these  organs  and  to 
lessen  their  work.  The  kidneys  are  not  supposed  to  be 
endocrine  glands  and  consequently  many  presume  that  they 
should  not  be  expected  to  respond  to  endocrine  therapy. 

Despite  this,  there  are  a  few  indications  that  preparations 
of  an  organotherapeutic  character  have  been  used  in 


NEPHRITIS  331 

Bright's  disease  with  what,  to  say  the  least,  must  be  consid- 
ered as  amelioration. 

Renal  Impermeability.  There  are  quite  a  number  of  ar- 
ticles in  medical  literature,  especially  in  the  French  journals, 
in  regard  to  the  value  of  renal  glomerular  substance  in  the 
treatment  of  certain  forms  of  what  the  French  call  "renal 
impermeability".  In  other  words,  conditions  which  are  akin 
to  Bright's  disease,  whether  accompanied  by  albuminuria 
and  casts,  or  not,  may  be  considered  as  in  the  category  of 
renal  impermeability.  In  all  of  these  cases  there  is  a  les- 
sened amount  of  urinary  solids.  The  specific  gravity  ordi- 
narily is  very  low  and  there  is,  or  not,  as  the  case  may  be, 
a  greater  or  less  degree  of  albuminuria.  The  dreaded  out- 
come is  uremia. 

The  feeding  of  renal  glomerular  substance  in  such  cases 
increases  the  amount  of  urine  very  definitely.  It  also  les- 
sens albuminuria  of  a  certain  type.  If  I  am  asked  which 
type  of  albuminuria  would  respond  to  organotherapy  and 
which  would  not,  I  can  not  answer  the  question,  because  I 
do  not  know — in  advance.  In  fact,  I  know  of  no  way  to 
find  this  out  except  when  an  opportunity  comes  to  use  treat- 
ment of  this  kind  and  then  if  the  albuminuria  is  noticeably 
lessened  or  entirely  eliminated,  we  presume  that  there  must 
be  a  reason  for  it  connected  with  the  treatment  and,  on  the 
other  hand,  if  it  is  not,  we  class  it  with  those  albuminu- 
rias  of  the  more  serious  type  which  organotherapy  cannot 
reach.  It  is  all  very  unscientific  I  know,  but  what  would  you 
do  if  you  had  Bright's  disease  and  the  doctors  had  given 
you  up  and  somebody  came  along  and  said  that  there  had 
been  a  case  in  a  neighboring  town  who  took  some  organo- 
therapy and  had  been  benefited?  Would  you  not  use  the 
organotherapy  yourself?  It  happens  that  quite  a  number 
of  physicians  have  chosen  to  do  this,  not  merely  in  their 
practice,  but  on  their  own  selves,  and  there  have  been 
enough  results  from  products  of  my  own  laboratory  to  con- 
vince me  that  suggestions  of  the  French  are  based  upon 
sound  reasoning  and  experience. 

Early  Clinical  Tests.  As  far  back  as  1869,  the  famous 
but  much-maligned  Brown-Sequard  expressed  the  belief 
that  the  kidneys  produced  an  internal  secretion,  and  in  1892, 
with  his  associate  d'Arsonval,  reported  a  series  of  experi- 
ments which  show  that  the  administration  of  renal  extract 
postponed  uremic  manifestations  and  prolonged  the  lives  of 
nephrectomized  animals.  Prot.  Tessier,  of  Paris,  applying 
the  results  ot  a  good  deal  of  experimental  physiology  in 


332  PRACTICAL  ORGANOTHERAPY 

therapeutics,  later  found  that  the  administration  of  a  gly- 
cerin extract  of  kidney  substance,  caused  a  diminution  and 
sometimes  complete  disappearance  of  certain  serious  symp- 
toms, such  as  dyspnea,  headache  and  vomiting  of  severe 
renal  affections.  It  is  the  opinion  of  a  number  of  French 
writers  that  "favorable  results  from  the  use  of  renal  sub- 
stance may  be  looked  for  in  uncomplicated  cases  of  nephri- 
tis." When  cardiac  complications  have  risen,  this  treat- 
ment is  not  so  likely  to  be  effectual.  Renaut,  of  Lyons,  be- 
lieves that  preparations  of  this  type  constitute  one  of  the 
most  active  and  effective  means  of  treating  conditions  that 
are  associated  with  renal  insufficiency.  This  form  of  or- 
ganotherapy was,  at  the  time  he  was  writing  (1903),  con- 
sidered to  be  "better  than  any  means  at  present  known" 
because  "it  opens  up  the  kidney  incapacitated  by  the  edema 
of  uremia."  This  writer  continues:  "This  method  has  the 
advantage  over  others  in  that  it  reduces  in  a  decided  manner 
the  albumin  passed  by  the  defective  kidneys,  at  the  same 
time  frequently  restoring  their  full  activity.  It  can,  there- 
fore, be  used  to  favor  the  restoration  of  the  epithelia,  which, 
in  numerous  cases,  is  histologically  possible.  No  other 
form  of  treatment  applied  in  nephritis  has  been  known  to 
do  this."  (Bull.  d.  I'Acad.  Med.,  Paris,  1904,  Vol.  50,  Page 
99.) 

Prof.  L.  Hallion,  also  of  Paris,  believes  that  the  general 
fundamental  influence  of  organotherapy  is  in  evidence  fol- 
lowing the  use  of  renal  preparations.  That  is,  an  extract  of 
an  organ  acts  especially  by  stimulating  the  activity  and  re- 
generation of  the  corresponding  cells  which  may  be  dis- 
turbed. And  clinical  experience  indicates  that  it  is  likely 
that  there  may  be  a  remarkable  influence  from  this  form  of 
treatment,  especially  in  the  reduction  in  a  large  degree  of 
the  accompanying  albuminuria.  Hallion  believes  that  ex- 
tracts of  kidney  substance  have  the  power  directly  to 
influence  the  passage  of  albumin  through  the  kidneys  and 
others  believe  that  these  preparations  also  play  an  antag- 
onistic and  neutralizing  part  over  certain  poisonous  sub- 
stances which  undoubtedly  are  factors  in  the  production  of 
the  disorders  in  question. 

I  am  not  prepared  to  state  why  the  renal  permeability  is 
increased  nor  how  the  elimination  of  albumin  is  sometimes 
lessened  in  so  remarkable  a  fashion  as  has  happened  fol- 
lowing the  use  of  preparations  of  this  kind.  I  do  not  think 
that  the  glomerular  tissue  of  the  kidney  contains  a  hormone, 
but  at  least  I  know  that  it  has  been  used  empirically  for 


NEPHRITIS  333 

years  with  satisfactory  results.  For  this  reason  I  am  per- 
fectly willing  to  use  it  whenever  opportunity  is  offered  to 
me. 

Pluriglandular  Renal  Therapy.  Renal  Co.  (Harrow er) 
contains  the  desiccated  glomerular  tissue  of  healthy  kid- 
neys, to  which  is  added  an  equal  dose  of  three  grains  of 
total  pancreas  substance  for  two  reasons:  Practically  all 
cases  of  kidney  insufficiency  have  an  alimentary  factor  of 
greater  or  less  prominence,  and  it  is  well  known  that  the 
pancreas  encourages  digestion  and  general  alimentary  effi- 
ciency. The  second  reason  for  the  addition  of  this  pro- 
duct is  that  the  pancreas  is  a  direct  antagonist  to  adrenal 
irritability  and  the  toxemia  connected  with  nephritis  neces- 
sarily keeps  the  adrenal  glands  functionally  "on  edge,"  and 
this  physiological  antagonism  to  hyperadrenia  is  an  advan- 
tage, not  merely  from  the  standpoint  of  the  associated  high 
blood-pressure  which,  as  is  well  known,  is  quite  common  in 
renal  cases,  but  also  from  the  standpoint  of  the  general 
metabolic  imbalance  which  usually  accompanies  various 
phases  of  Bright's  disease. 

The  use  of  Renal  Co.  (Narrower)  in  functional  renal  dif- 
ficulties is  worth  while.  One  cannot  expect  to  soften  a  hard- 
ened kindney,  nor  to  change  a  serious  structural  disorder  of 
these  organs,  but  in  many  cases  of  Bright's  disease  of  the 
various  types,  both  acute  and  chronic,  there  is  a  fairly  large 
functional  element  which  the  administration  of  this  formula 
has  helped  to  control  in  a  satisfactory  manner. 

In  addition  to  the  dietetic  regulations  so  necessary  in 
these  cases,  and  every  effort  to  lessen  toxemia,  I  recommend 
the  use  of  this  preparation  in  doses  of  from  six  to  eighteen 
grains,  three  or  four  times  a  day  with  food.  A  larger  dose 
in  the  few  serious  cases  for  a  shorter  time  and  a  smaller 
dose  continued  for  several  months  in  chronic  cases. 

An  Interesting  Case  Report.  I  feel  prompted  to  close 
this  short  chapter  with  a  report  from  a  physician  in  Oak- 
land :  "I  have  had  some  experience  with  your  preparation, 
list  No.  85,  Renal  Co.  (Harrower) ,  which  may  interest  you : 

"A  young  married  woman,  a  student  at  the  university, 
was  informed  by  the  physician  of  the  infirmary  that  she 
had  a  very  bad  mitral  lesion  with  failing  compensation.  She 
stopped  school  and  some  two  years  later  consulted  me,  in- 
forming me  that  she  was  pregnant  nearly  two  months. 
Within  ten  days,  before  she  had  time  to  get  any  relief  for 
the  heart,  she  developed  acute  appendicitis,  necessitating 
an  operation.  The  nausea  of  pregnancy  had  been  relieved 


334  PRACTICAL  ORGANOTHERAPY 

before  the  operation  by  your  Placenta  Co.  While  it  de- 
veloped again  at  the  time  of  operation,  it  responded  within 
three  days  to  the  above  named  preparation. 

"When  she  was  about  five  months  pregnant,  her  urine 
showed  a  very  low  specific  gravity,  about  one  per  cent,  of 
albumin,  and  other  indications  of  kidney  embarrassment. 
Then  she  was  given  the  Renal  Co.  After  its  use  for  two 
months,  together  with  a  regulated  diet  and  rest,  the  urine 
shows  no  albumin,  normal  spec,  gravity,  and  she  promises 
to  go  to  full  term.  I  cannot  help  but  feel  that  we  owe  a 
good  deal  to  organotherapy." 


SECTION  V.    CHAPTER  27 
ENDOCRINE  ASPECTS  OF  OBESITY 


To  facilitate  the  answering  of  literally  dozens  of  questions 
about  obesity  of  various  varieties,  I  want  to  dictate  a  few 
brief  statements  of  my  opinions.  These  are  purely  sugges- 
tive, and  at  the  outset  I  must  emphasize  the  necessity  for 
considering  this  particular  aspect  of  these  cases  in  conjunc- 
tion with  every  other  possible  associated  condition  and 
treating  the  patient  as  a  whole. 

Most  Frequent  in  Women.  Many  of  the  cases  referred  to 
in  these  queries  are  women,  and  a  large  proportion  of  them 
are  related  in  some  way  to  a  disturbance  of  ovarian  func- 
tion. For  example,  one  of  them,  after  the  birth  of  her  first 
child,  began  to  increase  in  weight  and  gained  sixty  pounds 
in  a  year;  another  one,  quite  similarly,  after  marriage 
gained  in  weight  from  150  pounds  to  240  pounds  in  about 
the  same  period.  In  a  third  case,  a  girl  developed  a  com- 
plete amenorrhea  soon  after  menstruation  was  established, 
and  by  the  time  she  was  of  age  she  weighed  190  pounds- 
height  5  feet,  3  inches.  And  so  on. 

All  of  these  cases  mentioned,  and  the  majority  of  the 
other  cases  of  obesity  in  women  that  are  related  to  dysovar- 
ism,  are  typical  cases  of  endocrine  obesity.  They  involve 
the  ovaries,  and  with  them  the  other  endocrine  glands,  nota- 
bly the  thyroid  and  pituitary.  It  is  not  so  difficult  to  see 
how  these  glands  became  involved.  Presuming,  for  the  mo- 
ment, that  the  thyroid  is  involved  secondarily,  may  it  not  be 
due  to  the  fact  that  the  abnormal  ovarian  function  occupies 
the  thyroid  so  unusually  that  it  cannot  accomplish  its  other 


ENDOCRINE   OBESITY  335 

duties  and  there  is  a  hypothyroidism,  resulting  in  a  lowered 
oxidation  with  a  lessened  B.  M.  R.,  and  a  considerable  de- 
gree of  obesity? 

Just  yesterday  I  saw  a  girl  of  fourteen  who  weighs  nearly 
200  pounds  (height  5  ft.,  6  ins.)  and  whose  B.  M.  R.  was 
—  16.6.  A  few  weeks  previously  I  saw  another  girl  of  16 
whose  B.  M.  R.  was  —26,  who  had  also  an  ovarian  dis- 
turbance and  whose  weight  was  180  Ibs — height  5  ft.  4  ins. 

Menopausal  Adiposity.  There  is  another  form  of  obesity 
in  women  that  is  connected  with  ovarian  dysfunction  and 
is  usually  found  at  or  near  the  change  of  life,  when  the  nat- 
ural functional  ovarian  insufficiency  manifests  itself.  This 
condition  is  due  chiefly  to  the  removal  of  the  influence  of 
the  ovarian  hormone  to  which  the  body  has  been  accustomed 
for  about  30  years,  and  like  all  other  endocrine  conditions, 
involves  the  associated  glands.  Such  an  ovarian  adiposity 
practically  never  is  found  without  involvement  of  the  two 
glands  which  are  intimately  wrapped  up  with  ovarian  func- 
tion, that  is,  the  thyroid  and  pituitary.  In  these  cases  the 
amount  of  adeps  can  be  considerably  lessened  when  the  dys- 
ovarism  is  modified  by  indicated  organotherapy. 

Obesity  in  Children.  Every  so  often  we  are  importuned 
about  some  unusually  fat  child.  The  prospects  are  only  fair, 
however.  A  very  interesting  paper  by  Mouriquand  (Lyon 
Medical,  Nov.  10,  1920)  directs  attention  to  the  incidence 
of  incipient  obesity  in  children  of  obese  parents.  He  also  has 
noted  that  early  inherited  obesity  frequently  precedes  dia- 
betes, and  calls  attention  to  the  fact  that  in  such  cases  of 
early  obesity  diabetes  is  developed  before  forty  in  nearly  all 
cases ;  that  when  the  inherited  obesity  does  not  develop  until 
late,  the  percentage  is  only  50  per  cent,  and  when  the  obesity 
is  acquired  the  ratio  is  15  per  cent.  This  writer  urges  an 
effort  to  modify  the  parental  obesity,  and  especially  in  preg- 
nant women.  In  cases  where  the  endocrine  glands  show 
insufficiency,  organotherapy  is  indicated,  and  Mouriquand 
refers  to  a  girl  at  puberty  threatened  with  what  was  pre- 
sumed to  be  the  adiposo-genital  syndrome,  to  whom  he 
recommended  thyroid,  ovarian  and  pituitary  treatment  in 
turn  for  ten  days  each,  or,  as  he  writes,  "the  three  may  be 
given  combined."  I  prefer  the  latter  plan  for  reasons  which 
I  have  explained  elsewhere. 

Many  an  obese  child  is  suffering  from  hypothyroidism ;  a 
few  of  them  have  a  thyro-pituitary  dystrophy,  and  the  same 
fundamental  principles  and  therapeutic  measures  apply  in 
these  children  as  in  adults. 


336  PRACTICAL  ORGANOTHERAPY 

Thyroid  Obesity.  Certain  cases  of  obesity  are  due  purely 
to  hypothyroidism,  though  involvement  of  the  associated 
glands  commonly  occurs.  The  proteolytic  properties  of  the 
body  are  slowed,  the  metabolism  is  very  seriously  lessened, 
and  there  is  a  natural  retention  of  unoxidized  material, 
much  of  which  seems  to  be  metamorphosed  into  fat  and  de- 
posited as  such.  These  hypqthyroid  patients  have  the  regu- 
lar signs  of  thyroid  insufficiency  already  discussed,  and  in 
every  respect,  from  the  inactivity  of  the  mind  or  of  the 
sweat  glands,  circulation  or  digestion,  they  are  below  par. 

Endocrine  Obesity  of  Non-Thyroid  Origin.  Some  months 
ago  a  letter  came  to  my  desk  inquiring  "whether  there  is 
anything  in  the  line  of  organotherapy  that  is  beneficial  in 
the  treatment  of  obesity  except  thyroid."  In  my  reply  I 
stated  that  while,  of  course,  one  expects  that  endocrine  obes- 
ity usually  involves  the  thyroid  gland,  it  is  perfectly  true 
that  the  deficient  oxidation  and  general  cellular  laziness 
which  one  expects  in  hypothyroidism  favors  a  condition  of 
sub-oxidation  and  obesity,  and  this  is  the  reason  that  so 
many  patients  take  thyroid  indiscriminately  as  a  remedy 
for  obesity — and  sometimes  rue  it.  As  a  matter  of  fact, 
the  administration  of  thyroid  gland  in  cases  of  obesity  is 
not  good  practice  unless  one  has  definite  information  that 
the  thyroid  gland  is  responsible  for  the  trouble,  and  even 
then  the  thyroid  should  be  given  very  carefully  and  under 
the  closest  supervision.  The  Thyroid  Function  Test  usually 
indicates  the  degree  of  thyroid  apathy  which,  of  course, 
varies  very  much  in  different  cases.  The  metabolic  rate  is 
uniformly  low.  The  elimination  as  measured  by  the  urin- 
alysis  is  always  deficient. 

The  Pituitary  Factor.  I  believe  that  in  many  cases  of 
obesity  the  pituitary  gland  is  equally  involved.  Undoubt- 
edly, the  pituitary  is  related  to  obesity,  for  in  a  typical 
pituitary  insufficiency  (Froehlich's  syndrome)  there  is  not 
merely  a  functional  gonad  insufficiency  and  atrophy  of  the 
sex  glands,  but  adiposity  to  an  unusual  degree,  is  the  rule. 
The  pituitary  aspect  of  these  cases  is  determined  chiefly  by 
the  estimation  of  sugar  tolerance,  for  it  happens  that  in 
hypopituitarism  there  is  not  merely  asexualism,  obesity  and 
a  lowered  B.  M.  R.,  but  the  tolerance  to  sugar,  which  is  ar- 
rived at  by  testing  the  urine  periodically,  is  very  high  and 
sometimes  these  patients  can  take  300  to  500  grams  or  more 
of  glucose  without  any  resulting  glycosuria. 

Dieffenbach  (Chironian,  Jan.,  1915)  goes  quite  fully  into 
the  pituitary  aspects  of  obesity.  Where  the  adipose  patient 


ENDOCRINE  OBESITY  337 

has  acquired  a  high  tolerance  for  sugars  one  may  expect  the 
resultant  accumulation  of  fat.  Transient  pplyuria  often  oc- 
curs in  these  cases,  due,  he  states,  to  posterior  lobe  dysfunc- 
tion. In  such  individuals  amenorrhea  is  frequent  and  ana- 
phrodisia;  there  is  constipation,  drowsiness  and  torpidity. 
"This  pictures  many  cases  of  obesity  occurring  in  practice, 
which  do  not  usually  respond  to  diet  and  are  thus  proven 
to  be  due  to  a  distinct  pathological  lesion." 

The  distribution  of  the  fat  is  of  special  interest.  Dieff en- 
bach  refers  to  the  fact  that  the  countenance  becomes  plump 
and  gross,  and  the  double  chin  grows  early;  the  fat  seems 
to  favor  the  waist,  abdomen  and  chest,  and,  of  course,  there 
is  impairment  of  both  respiration  and  circulation,  dyspnea, 
and  other  symptoms  due  largely  to  fatty  deposits  in  the 
mediastinum  and  pericardium. 

Again,  Harvey  G.  Beck,  of  Baltimore,  has  drawn  special 
attention  to  the  distribution  of  fat  in  the  pituitary  types  of 
obesity.  Attention  has  been  called  particularly  to  the  exces- 
sive development  of  pads  of  fat  on  the  hips.  Beck  connects 
this  with  anterior  lobe  insufficiency,  and,  as  a  result  of  or- 
ganotherapy, in  a  number  of  cases  there  has  been  an  in- 
crease in  the  amount  of  fat  in  the  upper  part  of  the  body, 
with  a  corresponding  decrease  in  the  fat  on  the  hips,  chang- 
ing the  physical  contour  of  the  individuals  quite  materially. 

According  to  Klein  (Therapeutic  Notes,  July,  1921),  the 
posterior  lobe  of  the  pituitary  may  be  involved  with  a  re- 
sulting obesity,  which  has  certain  important  distinguishing 
characteristics.  There  is  a  well-marked  accumulation  of 
adipose  tissue  in  the  lower  abdominal  wall.  It  is  some- 
times described  as  girdle  obesity.  In  such  persons  this  gir- 
dle extends  from  the  flanks  downwards  to  the  front  of  the 
abdomen  from  the  umbilicus  to  the  mons.  Of  course,  these 
people  ordinarily  have  evidence  of  obesity  in  other  parts  of 
the  body,  but  according  to  Klein :  "If  you  can  see  the  girdle 
you  may  be  sure  that  there  is  pituitary  involvement." 

Confirmatory  evidence  of  the  hypopituitaric  aspects  of 
obesity  is  found  in  a  slow  pulse,  subnormal  temperature, 
lethargy,  and  intestinal  atony.  In  these  cases  the  sugar 
tolerance  test  already  referred  to  is  an  important  differential 
diagnostic  measure,  as  is  also  the  experimental  adminis- 
tration of  the  posterior  pituitary  principle  hypodermically. 
Liq.  Hypopysis  (U.  S.  P.)  may  be  injected  in  5-minim  doses 
daily  and  increased  gradually  to  30  or  even  40  minims.  The 
point  of  tolerance  is  indicated  when  the  patient  complains 
of  intestinal  cramps,  and,  of  course,  in  such  individuals  the 

22 


338  PRACTICAL  ORGANOTHERAPY 

blood-pressure  should  be  found  to  be  within  reasonable  lim- 
its before  the  treatment  is  given.  Klein  says  the  "hypo- 
pituitary  patients  frequently  can  tolerate  2  to  3  cc.  of  Pituit- 
rin."  I  must  say  here  that  I  have  never  seen  a  case  of  pit- 
uitary obesity  in  which  there  was  not  associated  with  the 
pituitary  factor  a  well-defined  hypothyroidism.  These  two 
things  go  together  almost  invariably.  The  treatment,  nat- 
urally, is  to  replace  the  missing  pituitary  hormone,  and  we 
have  a  formula  called  Pituitary  Co.  (Narrower)  for  these 
cases,  which  is  a  combination  of  equal  parts  of  the  anterior 
lobe  substance  and  the  total  gland,  which  seems  to  be  more 
efficacious  than  either  of  the  two  ingredients  singly. 

In  cases  with  a  more  marked  pituitary  aspect  the  ovarian 
dysfunction  is  usually  of  a  more  serious  and  complete  type. 
Quite  often  these  people  have  a  low  blood-pressure,  are  very 
tired,  and  have  other  indications  that  an  adrenal  insuffi- 
ciency complicates  matters.  A  good  reason  for  this  would 
be  the  natural  accumulation  of  the  wastes  which  would  be 
burned  up  through  the  intervention  of  the  thyroid  and  allied 
glands,  but  which  remain  unoxidized  and,  like  other  poisons, 
serve  to  play  out  the  adrenals. 

The  Treatment  of  Obesity.  The  treatment  of  these  cases 
should  always  include  an  attempt  to  reestablish  obviously 
deficient  endocrine  activity,  and  in  the  first  type  discussed- 
obesity  in  women — I  always  advise  Thyro-Ovarian  Co. 
(Harrower)  for  two  months  at  least.  In  individuals  who 
menstruate,  one,  three  times  a  day,  for  ten  days,  then  two, 
three  times  a  day  for  the  ten  days  immediately  before  men- 
struation, and  none  at  all  for  the  ten  days  beginning  at  the 
onset  of  the  flow.  In  such  individuals  the  treatment  later 
may  be  amplified  by  changing  to  Gonad-Ovarian  Co.  (Har- 
fower) — a  similar  formula  which  is  reenforced  with  a  gen- 
erous dose  of  anterior  pituitary  substance.  In  some  cases 
where  the  evidences  of  hypothyroidism  are  very  well 
marked,  it  is  sometimes  advisable  to  increase  the  amount  of 
thyroid,  and  may  be  done  by  using  Thyroid  Co.  (Harrower) 
No.  9  (grs.  1/2)  >  °ne  dose  a  day  for  a  week ;  then  two  doses  a 
day  for  a  week ;  three  doses  a  day  for  the  third  week ;  and 
four  doses  a  day  (two  grains  a  day)  for  the  fourth  week, 
omitting  it  entirely  during  the  fifth  week,  and  then  starting 
up  the  ladder  again;  thus  finding  out  from  the  patient's 
response  what  the  optimal  dosage  is,  and  watching,  of 
course,  very  carefully  not  to  overdo  the  thyroid  medication. 
All  of  this  is  .being  done,  as  mentioned  previously,  while  I 
attempt  to  regulate  the  thyroid-ovarian-pituitary  aspects 


ENDOCRINE   OBESITY  339 

with  either  of  the  two  pluriglandular  formulas  referred  to. 

In  this  connection,  it  is  interesting  to  note  that  Edward 
C.  Titus,  of  New  York,  in  his  article  on  the  "Modern  Treat- 
ment of  Obesity,"  (Medical  Record,  Jan.  24,  1920),  con- 
siders the  subject  from  many  of  the  aspects  already  re- 
ferred to.  He  gives  passing  consideration  to  the  endocrine 
side,  and  says:  "In  view  of  the  fact  that  insufficiency  of 
the  endocrine  system  plays  so  important  a  part  in  the  eti- 
ology of  obesity,  I  have  occasionally  resorted  to  adminis- 
tration of  various  glandular  extracts,  single  or  combined, 
for  a  short  period  only,  as  indicated  in  the  individual  case. 
Thus,  I  have  often  employed  with  benefit  thyroid,  pituitary, 
ovarian  and  other  extracts,  as  well  as  the  combined  hor- 
mones." 

Remineralization.  An  important  point  worthy  of  con- 
sideration in  this  connection  has  been  frequently  referred 
to  under  the  heading  "Remineralization."  (See  Sec.  V, 
Chap.  25.)  People  of  the  type  under  discussion  all  have  a 
remarkably  low  chemical  capacity.  They  tend  to  accumu- 
late their  own  wastes,  and  since  many  of  these  are  of  an 
acid  nature,  they  rob  the  body  of  its  reserve  of  alkaline  min- 
eral salts.  It  will  be  found  on  careful  examination  that  a 
great  many  cases  of  obesity  are  in  various  stages  of  acid- 
osis ;  consequently  when  we  know  that  there  is  an  accumula- 
tion of  these  wastes  it  is  proper  to  supplement  the  organo- 
therapy with  remineralization,  which  I  usually  accomplish 
with  a  formula  called  Calcium-Phosphorus  Co.  (Narrower) , 
containing  magnesium  phosphate,  calcium  phosphate,  cal- 
cium glycerophosphate,  potassium  bicarbonate  and  sodium 
bicarbonate,  combined  in  suitable  dosage,  and  give  three 
grains  powdered,  with  a  generous  amount  of  water,  an  hour 
before  food  twice  a  day  for  about  a  month,  and  thereafter 
on  alternate  weeks  throughout  the  treatment. 

These  two  essential  measures — organotherapy  and  alka- 
linization — are  added  to  thorough  elimination  by  the  bowels, 
dietetic  control  and  good  hygiene.  It  makes  no  difference 
whether  one  or  another  of  these  factors  may  obscure  the 
real  reason  for  any  good  results  that  may  be  secured.  The 
point  is  to  help  the  patient  to  the  maximum,  and  as  quickly 
as  possible. 

Of  course,  it  must  be  remembered  that  there  is  a  form  of 
adiposity  known  as  "exogenous  obesity"  which  is  due  to 
external  circumstances  and  not  to  any  endogenous  condition. 
Exogenous  obesity  is  largely  a  matter  of  unwise  eating  and 
lack  of  exercise,  and  must  be  cared  for  accordingly.  Diet 


340  PRACTICAL  ORGANOTHERAPY 

will  not  benefit  a  purely  endogenous  case — this  is  a  diag- 
nostic measure.  Without  a  doubt,  it  is  possible  to  have  both 
the  endogenous  and  exogenous  forms  combined,  and  organo- 
therapy is  but  a  part  of  the  treatment  in  any  such  form  of 
obesity  and  invariably  should  be  combined  with  suitable  hy- 
giene, diet  and  elimination. 

Obesity  is  not  an  easy  condition  to  treat  from  the  stand- 
point of  the  internal  secretions,  but  whenever  there  is  an 
endocrine  side  to  a  case  with  obesity,  most  assuredly  this 
side  deserves  consideration  and  treatment  with  all  the 
others. 


SECTION  V.    CHAPTER  28 
SUGGESTIONS  IN  SIMPLE  GOITRE 


The  extent  of  the  literature  on  goitre  seems  almost  end- 
less. Hundreds  upon  hundreds  of  papers  are  devoted  es- 
pecially to  the  subject  or  take  it  up  in  conjunction  with 
associated  matters,  and,  naturally,  opinions  differ,  and  to 
read  30  or  40  of  these  papers  is  to  find  oneself  in  a  sea  of 
difficulty,  not  knowing  in  which  direction  to  seek  land. 

Definition  of  Simple  Goitre.  First  of  all,  it  will  be  neces- 
sary to  appreciate  what  is  meant  by  the  term  "simple  goi- 
tre." The  subject  has  been  given  considerable  study  from 
the  diagnostic  standpoint  in  a  previous  chapter  (see  Sec- 
tion IV,  Chapters  2  and  3).  When  the  thyroid  gland  is 
enlarged  and  is  fairly  firm  to  the  touch,  not  nodular,  not  es- 
pecially tender,  and  not  fluctuating,  it  is  probable  that  the 
goitre  is  of  the  "simple"  variety.  This  probability  is  em- 
phasized if  the  patient  happens  to  be  a  girl  at  puberty  or 
a  woman  with  a  menstrual  difficulty,  for,  as  we  have  seen, 
there  is  a  very  close  relationship  between  the  thyroid  and 
ovarian  functions. 

If  the  struma,  as  it  is  sometimes  called,  is  a  part  of  the 
syndrome  in  which  symptoms  of  hypothyroidism  clearly  are 
in  evidence,  we  have  confirmation  of  the  tentative  diagnosis 
of  "simple  goitre,"  for  in  a  majority  of  cases  this  condition 
is  associated  with  hypothyroidism. 

It  is  necessary  to  assure  oneself  that  the  thyroid  enlarge- 
ment is  not  the  beginning  of  another  kind  ot  goitre  that  is 
related  to  excessive  thyroid  functioning,  or  hyperthyroid- 


SIMPLE  GOITRE  341 

ism,  and  this  also  is  determined  by  the  clinical  symptoms 
which  have  been  fully  discussed  under  the  subject  of  hyper- 
thyroidism  (Section  IV,  Chapter  3,  and  Section  V,  Chapter 
10). 

The  Thyroid  Function  Test.  One  of  the  simplest  and 
easiest  means  of  determining  the  character  of  an  enlarge- 
ment of  the  thyroid  gland  is  the  therapeutic  test.  Ordina- 
rily, my  Thyroid  Function  Test  suffices.  This  consists  in 
administering  stepladder  doses  of  thyroid  extract  in  a  cer- 
tain routine  fashion  and  depending  upon  the  influence  upon 
the  pulse  during  a  period  of  four  or  five  days  for  indica- 
tions as  to  whether  the  thyroid  is  sensitive  or  apathetic. 
(The  Thyroid  Function  Test  has  been  discussed  in  original 
articles  published  in  the  New  York  Medical  Record  of  No- 
vember 1,  1919,  "Clinical  Results  with  a  Method  of  Testing 
Thyroid  Function,"  and  April  16,  1921,  "Clinical  and  Lab- 
oratory Tests  in  Hyperthyroidism,"  and  is  given  further 
consideration  in  Section  IV,  Chapter  4,  of  this  book.)  If 
the  findings  indicate  the  condition  known  as  thyroid  sen- 
sitiveness, it  is  probable  that  the  goitre  in  the  case  is  not 
of  the  "simple"  variety  and  that  an  effort  will  have  to  be 
made  to  find  some  cause  for  the  thyroid  irritability,  which 
it  is  presumed  may  be  equally  the  cause  of  the  thyroid  en- 
largement. 

On  the  other  hand,  if  the  administration  of  the  14  grains 
of  thyroid  extract  (U.  S.  P.)  which  constitute  this  test  is 
followed  by  an  amelioration  of  certain  symptoms,  and  the 
patient  says  that  instead  of  feeling  somewhat  uncomfort- 
able during  the  last  day  or  two,  with  internal  nervousness 
and  feeling,  perhaps,  of  apprehension,  they  seem  to  be  bet- 
ter during  the  last  days  of  the  test  and  following  it,  and 
especially  if  the  pulse  record  does  not  indicate  any  marked 
increase — particularly  during  the  third  and  fourth  days  of 
the  test,  and  especially  if  the  pulse  ordinarily  is  somewhat 
less  than  the  normal  and  not  increased  or  only  slightly  so — 
we  may  presume  that  the  enlargement  of  the  thyroid  is 
related  to  a  condition  of  hypothyroidism,  and  that  treat- 
ment from  this  standpoint  is  likely  to  be  efficient. 

An  Explanation  of  Thyroid  Enlargement.  The  relations 
of  the  endocrine  glands  are  such  that  there  is  a  considerable 
degree  of  physiologic  dependency  the  one  upon  the  other, 
and  the  thyroid  gland  in  particular  responds  physiologically 
to  stimuli  as  well  as  to  the  subtle  call  which  urges  it  to  at- 
tempt to  regulate  or  make  up  for  some  related  deficiency. 
In  other  words,  the  thyroid  gland  may  be  enlarged  as  a  re- 


342  PRACTICAL   ORGANOTHERAPY 

suit  of  some  hormonic  stimulation  or  reflexly  as  a  result  of 
a  need  for  a  greater  service  on  its  part,  to  help  out  some 
associated  endocrine  deficiency.  It  happens  that  this  is 
most  commonly  the  case  in  girls  and  women  and  that  the 
thyroid  gland  enlarges  itself  very  often  in  a  well-meant  at- 
tempt to  encourage  a  fundamental  deficiency  or  gradually 
waning  ovarian  activity. 

In  these  cases  of  simple  goitre  with  hypothyroidism,  two 
therapeutic  measures  are  necessary:  (1)  to  lessen  the  phy- 
siologic call  upon  the  thyroid  or  to  regulate  the  ovarian  in- 
sufficiency, (2)  to  supplement  the  work  of  the  thyroid  and 
to  administer  thyroid  extract  in  order  to  make  it  unneces- 
sary for  the  thyroid  to  enlarge  itself  so  much. 

Endemic  Goitre.  In  passing,  it  is  necessary  to  mention 
a  type  of  goitre  which  is  of  geographical  importance.  It  is 
believed  to  be  endemic  in  certain  locations  because  of  the 
character  of  the  drinking  water.  McCarrison  has  made 
very  extensive  studies  in  India  and  has  come  to  the  con- 
clusion that  many  such  goitres  are  due  to  water-borne  in- 
testinal infections.  His  successful  treatment  of  these  goi- 
tres depends  largely  upon  measures  calculated  to  remove  the 
offending  bacteria  (which  are  supposed  to  be  ingested  in  the 
food  or  water)  and  artificially  to  increase  the  immunity  to 
these  organisms  by  means  of  suitable  vaccine  therapy. 

On  the  other  hand,  many  interesting  items  have  slipped 
into  the  literature  regarding  a  presumed  chemical  cause 
for  this  particular  form  of  "simple  goitre."  David  Marine, 
formerly  of  Cleveland,  has  done  a  lot  of  splendid  work  in 
the  "goitre  belt"  of  Northern  Ohio  and  has  studied  literally 
thousands  of  school  children  affected  with  goitre.  He  has 
come  to  the  conclusion  that  there  is  a  deficiency  of  iodin 
at  the  bottom  of  the  difficulty  and,  naturally,  suggests  suit- 
able iodine  therapy  both  as  a  prophylactic  and  a  therapeutic 
measure.  Marine  recommends  a  varying  dosage  of  a  satu- 
rated solution  of  sodium  iodide— 30  grains  given  in  3-grain 
doses  daily  to  each  school  pupil  in  the  5th,  6th,  7th  and  8th 
grades,  and  60-grain  doses,  given  in  6-grain  doses  each 
school  day,  for  pupils  in  the  9th,  10th,  llth  and  12th 
grades;  to  be  given  twice  annually  about  the  first  of  May 
and  December.  Incidentally,  Marine  remarks  that  they 
have  also  used  syrup  of  hydriodic  acid  or  syrup  of  fer- 
rous iodid  in  1-mil.  doses  daily  for  two  or  three  weeks,  re- 
peated twice  annually. 

In  this  connection  it  is  interesting  to  note  a  little  item 
that  appeared  in  one  of  the  Swiss  medical  journals  in  regard 


SIMPLE  GOITRE  343 

to  the  existence  of  endemic  goitre  in  the  Canton  of  Aarau. 
Here,  in  a  certain  village,  were  quite  a  large  number  of  in- 
dividuals with  "simple  goitre."  They  all  lived  on  one  side 
of  the  town,  whereas  the  permanent  inhabitants  of  the 
other  side  seemed  to  be  unusually  free  from  this  difficulty. 
Careful  investigation  disclosed  the  fact  that  the  goitre-free 
persons  were  in  the  habit  of  securing  their  salt  from  cer- 
tain outcroppings  and  on  investigation  this  salt  seemed  to 
be  particularly  rich  in  iodid — quite  an  interesting  coinci- 
dence. 

The  treatment  of  the  endemic  type  of  simple  goitre  hap- 
pens to  be  quite  similar  to  the  treatment  of  other  forms  of 
simple  goitre,  as  we  shall  shortly  see. 

Suitable  Organotherapy.  When  the  thyroid  or  any  other 
ductless  gland  is  not  working  sufficiently,  and  we  have  some 
form  of  hypocrinism,  obviously  the  best  treatment  is  the 
judicious  administration  of  the  missing  substance.  Many 
hundreds  of  cases  of  goitre  can  be  cured  with  thyroid  extract 
alone,  though  many  hundreds  of  others  will  do  better  if  de- 
pendence is  not  placed  entirely  upon  the  one  single,  likely- 
to-be-useful  measure.  We  have  seen  that  many  of  these 
people  can  be  benefited  by  the  administration  of  certain 
forms  of  iodin,  and  for  years  I  have  been  in  the  habit  of 
combining  a  suitable  dose  of  the  ferrous  iodid  with  a  quar- 
ter-grain of  desiccated  thyroid  extract  and  suitable  doses 
of  nucleinic  acid  for  its  general  cell-  and  especially  white- 
cell,  blood-stimulating  influence.  This  formula,  known  as 
Iodized  Thyroid  Co.  (Har rower)  was  developed  in  the 
treatment  of  quite  a  number  of  cases  of  "simple  goitre"  and 
has  come  to  be  depended  upon  by  a  number  of  physicians, 
many  of  whom  have  had  an  opportunity  to  compare  this 
with  the  administration  of  thyroid  extract  alone  and  to 
conclude,  in  many  instances,  that  it  is  superior. 

I  am  not  averse  to  the  use  of  iodin  externally.  I  have 
sometimes  used  an  ointment  of  the  yellow  oxide  of  mercury, 
or  again,  more  commonly,  "lodex"  ointment,  and  have  ad- 
vised the  gentle  rubbing  of  a  small  portion  of  about  the 
size  of  a  Lima  bean  into  the  skin  above  the  thyroid  each 
night.  Sometimes,  in  suitable  cases,  where  there  is  a  notice- 
able ovarian  aspect,  it  has  been  my  custom  to  modify  the 
location  of  an  inunction  of  "lodex"  ointment,  with  or  with- 
out methyl  salicylate,  using  a  portion  about  the  size  of  a 
Lima  bean,  which  is  rubbed  into  the  skin  of  each  side  of  the 
abdomen  corresponding  to  each  ovarian  area  every  night 
on  retiring. 


344  PRACTICAL  ORGANOTHERAPY 

Supplementary  Organotherapy.  Attention  has  already 
been  called  to  the  importance  of  the  ovarian  aspects  of 
these  cases,  and  where  the  "simple  goitre"  has  originated 
in  connection  with  disturbed  ovarian  function,  manifested 
by  amenorrhea,  dysmenorrhea,  or  other  related  ovarian  find- 
ings, the  greatest  success  will  be  had  by  the  application  of  a 
treatment  that  is  directed  not  merely  at  the  thyroid  but 
also  at  the  ovaries,  and  in  these  cases  my  routine  is  to  ad- 
minister Thyro-Orarian  Co.  (Harroiver)  in  the  stepladder 
fashion  already  referred  to  (see  Section  V,  Chapter  5), 
for  at  least  three  months,  in  connection  with  the  "Ipdex" 
treatment  just  referred  to.  Later,  if  the  diminution  in  the 
size  of  the  goitre  is  not  complete,  or,  if  it  has  seemed  to 
reach  an  apparently  irreducible  minimum,  I  have  found 
advantage  in  combining  the  lodized-Thyroid  Co.  with  the 
Thyro-Orarian  Co.  (Harroiuer). 

Goitre  in  the  Male.  Fortunately,  thyroid  enlargement  is 
not  so  frequent  in  men  as  in  women,  though,  unhappily,  it 
seems  to  be  a  more  complex  affair;  at  least,  the  results  from 
presumably  indicated  treatment  are  not  usually  so  rapid 
and  spectacular.  The  same  fundamental  principles  apply, 
however,  and  the  treatment  with  lodized-Thyroid  Co.  (Har- 
row er)  and  local  inunctions  are  recommended.  In  my  per- 
sonal experience  a  higher  percentage  of  men  with  thyroid 
enlargement  had  with  it  evidence  that  the  pituitary  was  in- 
volved than  in  women;  in  other  words,  a  larger  number 
of  the  thyroid  cases  in  men  also  had  hypopituitarism,  in 
which  case  pituitary  therapy  had  to  be  added  to  the  thyroid. 
I  recall  two  cases  of  goitre  in  men  that  were  very  success- 
fully treated  by  the  use,  first  of  Iodized  Thyroid  Co.  and, 
later,  a  combination  of  this  formula  with  Pituitary  Co. 
(H&rrower)  (No.  47  on  our  list) ,  one  of  each,  4  times  a  day. 


SECTION  VI 

ENDOCRINE  QUERIES  AND  ANSWERS 


As  Director  of  The  Narrower  Laboratory,  I  am  requested 
every  day  to  answer  from  ten  to  thirty  letters  asking  for 
information  and  suggestions  in  regard  to  various  endocrine 
puzzles.  Occasionally  an  answer  of  necessity  must  be  fairly 
comprehensive  and  obviously  of  interest  to  many  others 
than  the  one  to  whom  it  was  directed  specifically.  There- 
fore some  of  these  answers  have  been  worked  out  a  little 
bit  more  fully  and  published  in  "The  Organotherapeutic 
Review"  for  the  good  of  as  many  of  its  readers  as  may  be 
interested. 

A  collection  of  these  queries,  carefully  arranged  and 
edited,  constitutes  this  section,  ivhich  it  is  believed  will  be 
a  very  welcome  and  practical  feature  in  this  new  edition. 

It  should  be  understood  that  my  answers  are  suggestive — 
not  intended  to  be  comprehensive  or  exhaustive — and, 
naturally,  often  refer  to  the  work  and  products  of  this  in- 
stitution. In  the  passage  of  years,  the  correspondence  which 
comes  to  my  desk  indicates  that  the  answers  to  some  of 
these  questions  have  proved,  often  in  many  instances,  to  be 
entirely  satisfactory;  in  other  words,  they  have  led  the  way 
to  results. 

1.    ARSENIC  AND  THE  ADRENALS 

Query:  "Several  years  ago  I  remember  reading  a  state- 
ment by  Sajous  that  arsenic  depressed  the  adrenal  func- 
tions. Is  this  upheld  by  later  work,  and  in  this  connection 
what  about  the  intravenous  injection  of  iron  cacodylate 
with  some  preparation  of  the  adrenal  gland  by  mouth? 
Would  a  combination  of  this  kind  be  logical  in  a  tubercular 
patient?" 

Answer:  I  am  not  at  all  sure  that  arsenic  really  de- 
presses the  adrenal  function ;  as  a  matter  of  fact,  all  poisons 
stimulate  the  adrenals  merely  because  it  is  the  function  of 
the  adrenal  glands  to  regulate  the  reaction  of  the  body  to 
toxemia,  and  of  course  any  amount  of  a  preparation  like 
arsenic  is  really  a  poison.  I  have  not  read  any  modification 
of  Sajous'  opinion,  but  he  is  a  well-balanced  man  and  I  am 
not  so  disposed  to  quarrel  with  him  as  has  been  the  habit 

345 


346  PRACTICAL   ORGANOTHERAPY 

of  some.  At  all  events,  when  the  conditions  are  such  that 
you  want  to  give  cacodylate  of  iron  and  a  tuberculosis  is 
associated  with  them,  certainly  the  adrenal  glands  have 
been  overworked,  probably  are  depleted,  and,  therefore, 
need  support.  I  think  your  idea  is  sound,  and  if  your 
patient  is  "all  run-down,"  asthenic  and  anemic,  and  you 
have  in  mind  to  use  the  cacodylate  of  iron,  I  think  it  would 
be  good  policy  to  give  the  Adreno-Spermin  Co.  (Narrower) , 
one  q.  i.  d.,  also.  Or,  better  still,  No.  68  on  our  list,  Sper- 
min-Hemoglobin  Co.,  because  it  is  a  combination  of  the 
above  formula  with  hemoglobin  for  use  in  asthenic  anemia. 
The  only  contraindication  to  this,  is  in  those  cases  where 
there  is  an  unusual  degree  of  sympatheticotonus,  due  to  the 
irritation  of  the  thyroid  gland  by  the  toxins  of  the  condi- 
tion which  we  are  attempting  to  treat. 


2.     FUNCTIONAL  HYPO ADRENIA  —  SERGENT'S 

TEST 

Query:  "I  have  a  case  of  a  women,  generally  asthenic, 
with  low  blood-pressure,  but  Sergent's  white  line  is  absent. 
There  appears  to  be  no  ovarian  dysfunction.  What  would 
you  suggest  for  this  case?  Do  you  consider  Sergent's  test 
reliable?" 

Answer:  The  general  asthenia  and  the  low  blood-pres- 
sure points  strongly  to  hypoadrenia.  Probably  the  elimina- 
tion of  the  urinary  solids,  and  especially  the  urea,  is  below 
normal,  and  the  woman  has  other  manifestations  of  muscu- 
lar atonicity,  as,  for  example,  cold  hands  and  feet,  intestinal 
sluggishness,  and  perhaps  ptosis,  and  general  functional 
tiredness. 

The  dermographic  sign  which  was  developed  by  Emile 
Sergent,  of  Paris,  and  called  "la  ligne  blanche  surrenale"- 
the  white  adrenal  line — is  not  to  be  expected  in  functional 
cases  of  the  degree  of  severity  mentioned  in  your  inquiry. 
The  white  adrenal  line  is  found  in  Addison's  disease,  and 
serious  degrees  of  adrenal  insufficiency  considerably  worse, 
I  should  imagine,  than  the  condition  present  in  your  patient. 
The  treatment  of  a  case  like  this  certainly  calls  for  adrenal 
support  in  the  usual  fashion.  I  know  of  no  better  combina- 
tion for  a  case  like  this  than  Adreno-Spermin  Co.  (Har- 
rower) — adrenal  substance,  a  small  dose  of  thyroid,  and 
spermin,  with  calcium  glycero-phosphate  as  the  excipient. 
I  would  give  the  patient  one  dose  at  each  meal  and  at  bed- 
time, or  four  a  day,  and  would  continue  it  for  a  minimum 


ATYPICAL  AMENORRHEA  347 

of  six  weeks;  longer  would  probably  be  better,  depending 
upon  the  length  of  time  that  the  patient  has  been  suffering 
from  this  condition.  The  more  chronic  and  long-standing 
the  condition,  the  longer  the  necessity  for  continuing  the 
organotherapy. 

In  answer  to  the  query  as  to  whether  I  consider  the  Ser- 
gent  test  reliable,  it  is  indeed  a  valuable  confirmatory  test 
in  severe  adrenal  insufficiency,  principally  the  organic  type, 
or  Addison's  disease.  One  cannot  expect  to  find  it  in  the 
simple  functional  hypoadrenia  so  common  in  every-day 
practice. 


3.    ATYPICAL  AMENORRHEA— THYROID  ORIGIN 

Query:  "In  a  case  of  amenorrhea  with  retained  menses, 
the  interval  varying  from  one  to  three,  or  even  four,  months, 
with  occasional  menorrhagia  lasting  as  long  as  twenty-six 
days  within  one  calendar  month,  what  would  be  your  method 
of  treatment  ?  Fibroids  and  disease  of  the  adnexa  have  been 
excluded.  What  is  the  diagnosis  ?" 

Answer:  When  an  individual  within  the  normal  men- 
strual age  has  menstruated  with  fair  regularity  at  fairly 
normal  periods  and  then  begins  to  drop  a  few  days,  a  week, 
01  a  month,  or,  as  in  this  case,  two  or  even  three  months, 
unquestionably  there  is  some  imbalance  in  the  mechanism 
which  determines  menstruation.  This  has  been  called  in 
the  title,  "Atypical  Amenorrhea,"  merely  because  this  is  the 
title  given  to  it  by  the  correspondent.  As  a  matter  of  fact, 
it  is  not  "atypical."  Amenorrhea  in  one  person  is  practically 
never  like  the  same  condition  in  another  person,  and  there 
are  all  shades  and  degrees  of  this  difficulty. 

When  the  patient  has  an  alternation  of  a  more  or  less 
long  period  of  amenorrhea  with  a  severe  menorrhagia  such 
as  is  referred  to — lasting  twenty-six  days — one  is  imme- 
diately reminded  of  a  severe  degree  of  hypothyroidism. 

This  gives  me  an  opportunity  to  emphasize  a  particular 
point  in  regard  to  the  relation  of  thyroid  insufficiency  and 
the  menses.  It  is  well  known  that  hypothyroidism  tends 
to  cause  amenorrhea  merely  because  the  thyroid  hormone 
has  as  a  part  of  its  important  work  the  stimulation  of  ova- 
rian function  and  the  initiation  of  menstruation  as  a  result 
of  it.  Therefore,  many  cases  of  amenorrhea  are  of  thyroid 
origin,  and  it  is  for  this  reason  that  thyroid  is  often  given 
in  conjunction  with  ovarian  substance  as  a  means  of  reg- 
ulating a  dysovarism  manifested  by  amenorrhea,  etc.  The 


348  PRACTICAL  ORGANOTHERAPY 

same  thing  applies  in  regard  to  pituitary,  and  our  prepar- 
ation, Thyro-Ovarian  Co.  (Narrower)  which  contains  thy- 
roid, pituitary  and  total  ovary,  is  given  for  this  purpose, 
and  for  these  valid  reasons. 

Now  to  explain  the  reason  why  a  hypothyroidism  can 
cause  amenorrhea  on  the  one  hand  and  a  serious  menor- 
rhagia  on  the  other.  If  the  hypothyroidism  is  a  cause  of 
an  ovarian  insufficiency,  we  have  a  perfectly  good  explan- 
ation for  the  amenorrhea,  but  if  hypothyroidism  causes 
cellular  infiltration — the  typical  manifestation  of  myxe- 
dema,  it  will  be  recalled — and  if  this  infiltration  involves  the 
uterine  musculature,  there  may  be  a  resultant  mechanical 
factor  which  will  prolong  an  otherwise  normal  flow.  For 
this  reason  those  who  have  studied  hypothyroidism  fre- 
quently call  attention  to  the  fact  that  hypothyroidism  may 
cause  amenorrhea,  and  in  other  instances  may  cause  quite 
a  serious  menorrhagia.  The  regulation  of  the  dysovarism 
may  benefit  either  the  amenorrhea  or  the  menorrhagia. 

The  treatment  of  these  cases  involves  the  regulation  of 
the  ovarian  dysfunction  with,  I  should  say,  Thyro-Ovarian 
Co.,  or,  if  it  is  preferred,  a  special  effort  should  be  made 
first  to  determine  whether  thyroid  insufficiency  is  present  by 
means  of  my  Thyroid  Function  Test. 


4    STUNTED  GROWTH— JOINED  EPIPHYSES 

Query:  "Which  of  your  preparations  would  help  a  boy 
of  15  who  is  not  deformed  but  who  has  only  attained  the 
height  of  an  average  child  of  10  ?" 

Answer:  Antero-Pituitary  Co.  (Harrower)  is  a  growth 
and  developmental  stimulant.  It  is  given  in  all  forms  of 
developmental  dystrophies,  and,  for  a  boy  of  15  who  is 
dwarfed  but  not  malformed,  I  would  give  five  grains  three 
times  a  day  for  four  out  of  every  five  weeks  for  a  minimum 
of  six  months.  In  cases  of  this  kind,  if  there  is  a  possibility 
that  the  boy  has  attained  his  maximum  growth  and  there- 
fore may  not  respond  to  organotherapy,  it  is  possible  to 
make  an  X-ray  picture  of  the  hand  and  note  from  it  if  the 
epiphyses  are  joined  or  not.  If  they  are  Joined  completely, 
the  chances  for  growth  obviously  are  not  good;  if  they  are 
not  joined,  there  are  indeed  very  good  possibilities  of  in- 
creasing the  height.  I  have  seen  as  high  as  four  inches 
added  to  the  stature  in  less  than  a  year  from  this  treatment, 
and  in  a  boy  of  15  too. 

A  report  came  to  me  not  long  ago  from  a  physician  in 


HYPERTHYROIDISM  349 

Portland,  Ore.,  about  a  case  of  a  young  man  of  18  whose 
height  at  the  beginning  of  treatment  was  4  ft.  6  in.  It 
seemed  advisable  to  use  organotherapy,  and  Antero-Pitui- 
tary  Co.  (Harrower)  was  given  in  the  usual  manner.  Dur- 
ing the  first  month  the  patient  is  said  to  have  grown  3/16 
of  an  inch,  during  the  second  month  almost  half  an  inch, 
during  the  third  month  there  was  apparently  no  change, 
but  in  the  fourth  month  the  total  additional  increase  was 
%  of  an  inch.  During  this  time  he  also  gained  in  weight 
and  the  parents  are  quite  delighted  with  the  change.  As 
I  have  said,  ordinarily  one  cannot  expect  much  in  the  way 
of  growth  stimulation  after  the  usual  time  of  puberty  since 
ossification  of  the  epiphyses  is  completed  soon  after  that 
time. 


5.    HYPERTHYROIDISM  WITHOUT  EXOPHTHALMOS 

Query:  "What  would  you  prescribe  for  a  girl  of  14  who 
has  hyperthyroidism  without  exophthalmos  and  with  a  nor- 
mal heart  action?  She  is,  however,  nervous  and  somewhat 
anemic." 

Answer -•  How  do  you  know  that  this  girl  has  hyperthy- 
roidism? She  may  have  what  is  called  "sympatheticotonia" 
or  one  of  the  symptoms  of  hyperthyroidism  without  actual 
thyroid  irritability.  This  can  be  quite  definitely  determined 
by  the  use  of  the  Thyroid  Function  Test,  which  is  referred 
to  elsewhere.  The  estimation  of  the  B.  M.  R.  (basal  meta- 
bolic rate)  will  confirm  this.  If  there  is  indeed  a  thyroid 
irritability,  every  effort  should  be  made  to  remove  foci  of 
infection  and  other  causes  of  the  irritation,  and  Pancreas 
Co.  (Harrower),  a  formula  based  upon  the  work  of  Dr. 
Andre  Crotti  of  Columbus,  Ohio,  is  advised.  This  formula 
is  No.  6  on  our  list  and  the  usual  dose  is  one  between  meals 
and  at  bedtime. 

I  know  of  no  better  remedy  for  the  anemia  than  Hemo- 
globin Co.  (Narrower),  which  is  given  one  or  two  doses 
three  times  a  day.  This  is  not  really  a  hormone  remedy 
but  rather  a  form  of  organotherapeutic  treatment  based 
upon  the  fact  that  hemoglobin  is  the  most  easily  absorbed 
and  useful  form  of  therapeutic  iron  that  we  know  of.  In 
this  formula  it  is  very  nicely  supplemented  by  nucleinic 
acid,  which  increases  the  white  cell  action,  and  spleen  sub- 
stance, which  is  accepted  as  a  hemopoietic.  Incidentally,  you 
will  find  that  it  does  not  further  accentuate  the  sympathetic 
irritability  as  is  often  the  case  with  arsenic,  etc. 


350  PRACTICAL   ORGANOTHERAPY 

6.    ADRENAL  SUPPORT  DURING  PREGNANCY 

Query:  "I  have  a  case  of  chronic  asthma  who  has  been 
on  your  Adreno-Spermin  Co.  with  marked  improvement. 
This  woman  lately  has  become  pregnant,  and  I  am  uncer- 
tain as  to  the  use  of  this  formula  in  such  cases.  She  is 
still  asthenic,  her  blood-pressure  is  now  110  systolic  (it  was 
considerably  lower) ,  and  she  has  the  fatigue  syndrome  to  a 
marked  degree." 

Answer:  In  regard  to  the  use  of  Adreno-Spermin  Co. 
in  pregnant  women,  I  know  of  no  detriment  from  the  ad- 
ministration of  a  formula  of  this  kind,  more  especially  as, 
in  this  instance,  the  patient  is  quite  asthenic  and  the  blood 
pressure  is  still  as  low  as  110.  If  she  has  a  tendency  to 
nausea  and  vomiting,  which  would  be  very  probable  with 
a  detoxicating  mechanism  depleted  as  hers  must  be,  No.  49 
on  our  list,  Placenta  Co.  (Harrower)  would  be  indicated 
also  to  favor  an  earlier  and  more  complete  immunity  to 
the  placental  proteins  which  it  is  believed  may  cause  the 
anaphylaxis-like  disturbances  of  early  pregnancy;  and 
which,  incidentally  may  cause  the  hypoadrenal  syndrome 
of  which  you  write. 


7.    NAUSEA  OF  PREGNANCY  A  PROTEIN 
SENSITIZATION 

Query:  "Please  give  an  explanation  of  your  new  method 
of  controlling  the  nausea  of  pregnancy." 

Answer:  It  is  quite  possible  that  the  nausea  and  vomit- 
ing of  pregnancy  is  a  form  of  anaphylaxis  or  protein  sen- 
sitization  resulting  from  the  absorption  into  the  system 
of  a  new  series  of  protein  substances  to  which  the  body  is 
not  accustomed.  It  will  be  recalled  that  most  women,  dur- 
ing the  first  few  weeks  of  pregnancy,  suffer  from  this  con- 
dition, usually  in  a  minor  manner,  and  that  in  the  course 
of  a  short  time  the  body  becomes  accustomed  to  handling 
these  unusual  substances  and  accommodates  itself  to  these 
circumstances. 

In  some  cases  the  character  of  these  poisons  is  perhaps 
different  from  what  it  is  in  others,  and  certainly  in  some 
women  there  is  a  greater  susceptibility  to  this  poisoning. 
This  is  particularly  true  in  individuals  who  are  already 
unduly  sensitive  to  proteins,  and  this  includes  women  who 
may  have  had  asthma  or  who  have  occasional  periods  of  hay 
fever,  or  are  susceptible  to  certain  foods,  such  as  straw- 


ENDOCRINE  EPILEPSY  351 

berries,  crab  meat,  eggs,  etc.  It  is  always  of  interest  to 
discover,  when  investigating  conditions  in  cases  of  vomit- 
ing of  pregnancy,  whether  the  individual  has  a  tendency 
towards  protein  sensitization. 

The  idea  of  treating  this  condition  by  means  of  placenta 
organotherapy  is  based  upon  the  fact  that  the  body  can 
accommodate  itself  to  conditions  that  are  brought  about 
artificially,  but  are  not  really  pathological.  It  will  be  re- 
called that  the  treatment  of  hydrophobia,  for  example,  is  the 
gradual  administration  of  a  poisonous  substance  to  which 
the  body  becomes  accustomed  and  immune  in  a  shorter 
time  than  the  bacterial  developments  can  be  consummated. 

At  all  events,  it  is  possible  to  favor  the  establishment  of 
an  immunity  to  the  placenta  proteins,  and  to  my  mind  this 
is  a  basic  reason  for  the  successes  that  have  followed  the  use 
of  Placenta  Co.  (Narrower)  in  many  cases  of  the  severest 
types  of  vomiting  and  nausea  of  pregnancy.  The  idea  is  to 
administer  a  fairly  generous  amount  of  this  formula  (No. 
49) ,  for  two  or  three  weeks,  and  it  has  been  found  in  many 
scores  of  cases — not  in  all  of  them,  however — that  within  a 
week  there  begins  to  be  a  mitigating  of  the  nausea  and  the 
vomiting  and  within  two  weeks,  if  there  is  going  to  be  a 
cure  at  all,  the  result  is  complete. 

I  do  not  want  it  to  be  understood  that  I  am  advancing 
this  as  a  panacea  for  the  nausea  of  pregnancy,  but  I  know 
that  many  cases  have  been  under  all  sorts  of  treatment, 
including  chloral  by  rectum,  morphin  hypodermically,  the 
various  synthetic  sedatives,  triple  bromides,  and  entire  rest 
in  bed  with  special  hygiene  and  diet,  and  were  cured  as  by 
a  miracle  within  ten  days  following  the  beginning  of  the 
placenta  therapy. 

The  best  method  of  dosage  is  to  give  ten  grains  three 
times  a  day  for  a  week  and  then  to  increase  the  dose  to 
fifteen  or  twenty  grains  three  times  a  day.  If  the  vomit- 
ing is  quite  continuous,  it  may  be  necessary  to  give  this 
placenta  preparation  at  a  time  and  under  circumstances 
when  it  can  be  retained,  if  necessary  using  sedatives  to  ac- 
complish this.  The  idea  is  to  get  the  absorption  of  this 
material  into  the  blood  and  thereby  bring  about  the  im- 
munity response. 

8.    THE  DIAGNOSIS  OF  ENDOCRINE  EPILEPSY 

Query:  "That  I  am  interested  in  your  products  you 
already  know  from  past  correspondence,  and  my  experience 


352  PRACTICAL  ORGANOTHERAPY 

with  your  Antero-Pituitary  Co.  in  a  number  of  cases  of 
epilepsy  prompts  me  to  ask  you  this  question :  How  can  you 
determine  in  advance  in  which  cases  you  may  expect  results 
from  this  treatment?  Have  you  some  way  to  find  this  out? 

"You  may  be  interested  in  the  following  recent  expe- 
rience: A  man  at  the  age  of  28  began  to  have  epilepsy 
which  for  ten  years  gradually  became  worse  in  spite  of 
treatment  by  a  number  of  physicians.  He  had  gone  through 
the  usual  bromide  road  and  when  I  saw  him  a  year  ago  at 
39,  he  was  having  five  to  eight  heavy  grand  mat  attacks 
daily.  For  a  year  now  he  has  been  taking  A.  P.  Co.  After 
the  first  month  the  character  of  the  attacks  changed.  After 
2y%  months  my  record  reads  'a  few  petit  mal  attacks  daily'. 
Occasionally  he  would  have  a  complete  attack.  Now  he 
goes  six  weeks  or  two  months  without  any  seizure.  He  is 
not  cured  yet,  but  he  is  certainly  a  different  man." 

Answer:  Your  experience  was  interesting,  and  the  more 
so  because  of  the  age  of  the  man  and  the  number  and 
severity  of  his  attacks. 

So  far  as  I  know  there  is  no  way  definitely  to  determine 
in  advance  whether  a  given  case  of  epilepsy  is  an  endocrine 
one  and  likely  to  benefit  from  organotherapy,  or  not.  Nat- 
urally if  there  are  clear-cut  signs  of  thyroid  insufficiency 
or  the  appearance  indicates  a  pituitary  case,  one  would  be 
justified  in  presuming  that  it  might  be  an  endocrine  case. 
But  even  this  does  not  give  one  the  kind  of  impression  that 
you  are  evidently  seeking. 

Suppose  for  one  moment  that  a  given  case  clearly  has  a 
thyroid-pituitary  dystrophy.  A  half  dozen  or  more  indica- 
tions may  establish  this  to  your  satisfaction.  This,  how- 
ever, is  no  therapeutic  criterion.  Merely  because  the  case 
very  clearly  may  involve  the  ductless  glands  does  not  prove 
that  the  endocrine  trouble  is  at  the  bottom  of  the  epilepsy, 
for  all  endocrine  cases  do  not  have  epilepsy! 

From  what  some  like  to  call  the  "scientific  aspect"  of  the 
subject  I  regret  to  say  that  it  is  not  possible  in  advance  to 
determine  whether  organotherapy  is  going  to  be  of  benefit 
in  a  given  case  of  epilepsy  or  not.  Yet,  your  own  expe- 
riences have  proved  to  your  satisfaction  that  the  use  of  my 
pluriglandular  formula  is  indeed  a  worth  while  procedure, 
and  I  can  quite  understand  that  you  must  have  had  some 
failures  you  did  not  report.  So  have  I ! 

As  a  matter  of  fact,  while  it  is  well  to  discover  as  many 
facts  as  possible  about  the  endocrine  side  of  a  given  case, 
this  only  favors  the  supposition  that  the  case  may  respond 


ENDOCRINE  EPILEPSY  353 

to  the  treatment  of  the  endocrine  feature,  but  does  not  by 
any  means  establish  it  in  advance.  Frankly,  while  I  am 
being  surprised  continually  by  the  reports  like  yours  that 
I  hear,  of  epileptics  who  have  been  treated  successfully  with 
Antero-Pituitary  Co.  (Harrower) ,  I  am  equally  discouraged 
about  the  very  problem  you  bring  up,  for  as  far  as  I  know, 
we  are  no  further  ahead  today  in  determining  the  prospects 
from  organotherapy  and  the  prognosis  of  a  case  than  we 
were  before  we  began  these  clinical  experiments.  As 
things  stand  we  know  very  positively  that  many  epilep- 
tics, chiefly  among  the  young  as  well  as  occasionally  in 
older  people,  have  been  benefited  by  the  use  of  this  pluri- 
glandular  therapy.  The  attacks  have  been  ended  entirely 
or  their  frequency  remarkably  changed  as  in  your  case; 
attacks  occurring  from  ten  to  twenty  or  more  times  a  day 
being  modified  so  that  seizures  occur  once  a  week ;  or,  again, 
very  severe  seizures  have  been  changed  in  severity,  i.  e., 
grand  mal  has  been  lessened  to  petit  mal.  We  know  that 
with  the  changes  in  the  epileptic  aspects  many  times  there 
has  been  benefit  to  other  aspects  as  well,  with  a  general 
increase  in  health  and  nutrition,  resulting,  undoubtedly, 
from  the  increased  endocrine  activities  which  we  were 
attempting  to  modify  in  the  hope  that  it  might  change 
the  epileptic  state.  I  know  these  results  have  occurred  in 
many  hundreds  of  cases,  but  our  figures  do  not  allow  us  to 
determine  the  relation  between  results  and  failures,  and,  of 
course  of  the  latter  there  have  been  fully  as  many  as  the 
former. 

As  I  see  it,  the  frank  answer  to  your  inquiry  is  "There 
is  no  way  to  determine  this  in  advance,"  but  I  must  say  that 
I  shall  never  see  an  epileptic  again  without  wanting  to  give 
him  the  benefit  of  the  doubt  and  treating  him  from  this 
standpoint,  and  if  we  fail  after  four  or  five  months  we 
have  done  no  worse  than  ten  thousand  other  doctors  with 
bromides. 

In  closing  it  must  be  emphasized  that  organotherapy 
often  is  the  means  of  determining  whether  a  given  case  of 
epilepsy  has  a  sufficiently  important  endocrine  aspect  to 
warrant  this  treatment.  True  enough,  it  is  unscientific, 
unfortunately;  but  if  we  handle  these  patients  right  those 
who  do  not  get  results  will  not  be  so  especially  disappointed 
because  we  have  warned  them  in  advance  of  the  limited 
prospects:  whereas,  those  who  do  get  results  cannot  find 
words  to  express  their  pleasure — and  their  opinions  of  their 
doctors ! 

23 


354  PRACTICAL   ORGANOTHERAPY 

9.    THE  ENDOCRINES  IN  MORPHIN  ADDICTS 

Query:  "I  am  very  much  interested  in  morphin  and 
drug  addiction,  and  have  come  to  the  conclusion  that  in  a 
well-established  addict,  the  glandular  secretions  are  dimin- 
ished to  a  great  extent  and  that  the  terrible  withdrawal 
symptoms  are  caused  by  an  antitoxin,  which  poisons  the 
patient,  the  toxin — the  morphin — not  being  there  to  coun- 
teract the  antitoxin.  Now  I  am  wondering  if  these  with- 
drawal symptoms  could  not  be  mitigated  by  the  adminis- 
tration of  some  endocrine  product.  I  should  very  much  like 
to  have  your  opinion  in  the  matter." 

Answer:  As  I  have  repeatedly  stated,  all  poisons  either 
stimulate  or  deplete  the  endocrine  glands.  The  morphinist 
is  always  a  case  of  hypocrinism,  and  the  desolate  picture 
that  we  so  often  see  is  sufficient  proof  of  this.  The  elimina- 
tion is  tremendously  low,  the  muscular  tonicity  is  lessened, 
constipation,  of  course,  is  the  rule,  the  urinary  wastes  are 
reduced  two  and  sometimes  three  hundred  per  cent.,  the 
cardiac  muscle  is  tired  out,  and  the  blood-pressure  is  prac- 
tically always  low.  In  fact,  hypoadrenia  is  the  proper  name 
for  the  most  usual  endocrine  symptom-complex  of  the  drug 
addict. 

I  am  not  at  all  sure  that  the  above  suggestions  about  the 
"antitoxin"  are  correct.  Of  course  it  may  be  that  the  body 
has  prepared  a  special  substance  to  neutralize  the  morphin 
and  that  the  removal  of  the  morphin  permits  an  excessive 
degree  of  toxemia  by  the  very  substance  that  was  intended 
to  neutralize  the  poisons  which  the  body  was  anticipating. 
Be  that  as  it  may,  the  removal  of  morphin  from  a  patient 
always  leaves  him  tremendously  depleted,  and  while  the 
withdrawal  is  being  carried  on  in  the  manner  suggested  by 
Dr.  Ernest  S.  Bishop,  of  New  York  City,  it  is  perfectly 
proper,  and  scientific,  too,  to  encourage  the  depleted  glands 
of  internal  secretion.  I  know  of  a  great  many  cases  of 
drug  addiction  who  have  been  treated  coincidentally  with 
Adreno-Spermin  Co.  (Harrower)  as  a  means  of  stimulating 
cellular  activity,  increasing  the  general  muscular  tone  and 
raising  the  blood-pressure.  This  antagonist  to  adrenal  in- 
sufficiency offers  a  service  to  the  organism  that  cannot  be 
secured  in  any  other  way.  It  is  perfectly  true,  if  the  pa- 
tient survives  the  serious  conditions  which  accompany  the 
removal  of  the  morphin  and,  in  some  ways,  can  be  per- 
mitted to  reestablish  some  degree  of  normalcy  in  his  gen- 
eral cellular  functions,  that  the  glands  of  internal  secretion 


MENORRHAGIA  355 

may,  in  course  of  time,  reestablish  themselves  fairly  satis- 
factorily; but  how  much  better  it  is  to  encourage  them 
when  in  their  greatest  need,  rather  than  to  let  them  work 
out  their  own  salvation. 

The  use  of  Adreno-Spermin  Co.  is  indicated  whenever 
there  is  cellular  laziness  and  the  fatigue  syndrome.  It  sup- 
ports the  adrenal  glands  and  thereby  increases  the  cellular 
chemistry  and  the  elimination  of  wastes.  It  also  stimulates 
unstriped  muscle,  increases  the  cardiac  power  and  raises  the 
blood-pressure,  and,  besides  this,  the  influence  upon  the  ali- 
mentary musculature  is  always  an  advantage  in  cases  of  the 
type  mentioned  where  constipation  is  the  rule. 

I  do  not  want  it  understood  that  this  is  the  treatment 
of  the  withdrawal  symptoms  of  drug  addicts ;  but  that  it  is 
an  adjuvant  of  extreme  value  and  fundamental  reasonable- 
ness is  a  fact  that  cannot  be  gainsaid. 

10.    EFFICIENT  THERAPY  IN  MENORRHAGIA 

Query:  "I  have  two  cases  of  severe  metrorrhagia  that 
have  been  treated  locally  and  also  with  horse  serum,  cal- 
cium chloride,  stypticin  and  other  measures.  Is  there  not 
something  in  organotherapy  for  cases  of  this  type  ?  Exam- 
ination shows  that  neither  of  these  cases  has  any  apparent 
organic  reason  for  the  heavy  flow." 

Answer:  If  it  is  indeed  true  that  both  of  these  women 
have  metrorrhagia  or  menorrhagia,  with  no  organic  cause, 
as  those  that  follow  a  miscarriage  or  accompany  fibroids,  I 
believe  that  the  functional  condition  is  more  likely  to  be 
modified  by  organotherapy  than  by  all  the  styptic  drugs 
that  we  have  been  in  the  habit  of  using.  Cotarnin  hydro- 
chloride  is  certainly  a  styptic,  but  it  only  has  a  temporary 
effect,  just  as  morphin  has  upon  him,  and  is  an  opium 
derivative,  by  the  way,  while  organotherapy  tends  very  de- 
cidedly to  remove  causes. 

In  cases  of  this  kind,  since  you  have  already  operated 
and  tried  other  measures  without  much  success,  surely  or- 
ganotherapy should  be  given  a  trial,  and  I  recommend 
Mamma-Pituitary  Co.  (Harrower)  for  three  reasons :  First, 
mammary  extract  antagonizes  ovarian  hyperactivity  and 
the  pelvic  congestion  dependent  thereon.  It  is  a  physio- 
logic pelvic  and  uterine  depletant,  and  many  articles  in  the 
literature  emphasize  this  anti-ovarian  influence.  Total  pit- 
uitary substance  tends  to  increase  uterine  tone  and  opposes 
the  bogginess  and  excessive  vascularity  of  the  pelvis,  such 


356  PRACTICAL   ORGANOTHERAPY 

as  one  expects  in  cases  of  this  type.  And  further,  it  is 
combined  with  mammary  substance,  with  very  decided  ad- 
vantage, and  many  times  I  have  proved  that  mammary 
therapy  alone  is  not  as  efficient  as  a  combination  of  mam- 
mary and  pituitary. 

You  will  note  from  our  literature  that  this  formula  also 
contains  a  small  dose  of  Bon  jean's  ergotin,  for  the  follow- 
ing reason:  Ergotin  is  known  to  be  a  uterotonic  remedy, 
and  has  been  successfully  used  many  times  in  menorrhagia. 
The  dose,  however,  is  not  sufficient  to  serve  as  a  styptic, 
but  it  sensitizes  the  uterus  and  renders  it  more  responsive 
to  the  organotherapy  given  simultaneously,  and  many  clin- 
ical experiences  show  that  its  addition  makes  the  other  two 
associated  remedies  more  efficient. 

This  formula  has  been  used  in  many  cases  with  success, 
and  I  trust  you  may  have  excellent  results  in  both  cases. 

There  is  an  ideal  method  of  administering  this  formula : 
When  the  flow  ceases  (this  may  not  be,  but  ordinarily  there 
is  a  period  of  cessation  of  the  flow) ,  omit  the  remedy  en- 
tirely  for  from  three  to  ten  days,  depending  upon  the 
severity  of  conditions.  During  the  next  period  of  a  week 
or  ten  days  give  one,  three  times  a  day  at  meals.  During 
the  week  prior  to  the  flow,  and  through  the  complete  flow, 
give  two,  three  times  a  day.  Continue  this  treatment  for 
at  least  three  menstrual  experiences,  or  preferably  for  a 
minimum  of  three  months.  It  may  be  necessary  to  prolong  it 
still  more.  You  realize  that  one  cannot  state  figures  defi- 
nitely where  the  flow  varies  so  much,  both  in  amount  and 
time.  Some  flow  very  heavily  for  a  week  or  ten  days,  and 
then  are  free  for  two  weeks  or  so;  while  others  flow  for 
four  or  five  days,  at  intervals  of  a  week;  and  still  others 
have  a  dribbling,  insignificant  flow  virtually  all  the  time. 
These  different  manifestations  of  menorrhagia  make  it  im- 
possible to  set  a  hard  and  fast  plan  for  the  administration 
of  this  remedy.  The  point  is  to  omit  it  when  there  is  no 
flow  or  likelihood  of  it  and  to  push  it  prior  to  the  beginning 
of  the  flow  and  completely  through  it. 

11.    PROSTATIC  HYPERTROPHY 

Query:  "Is  the  prostate  a  gland  of  internal  secretion, 
and  are  there  any  chances  with  organotherapy  in  prostatic 
hypertrophy?" 

Answer:  Yes,  it  is  now  accepted  as  such  by  many.  Based 
upon  the  not  unreasonable  theory  that  prostatic  hypertro- 


GOITRE   IN   GIRLS  357 

phy  so  common  in  elderly  men  may  be  due  to  a  compensa- 
tory activity  of  this  gland  brought  about  as  Nature's  at- 
tempt to  supplement  the  hypocrinism  so  usual  at  this  age 
and  especially  the  expected  waning  endocrine  function  of 
the  gonads,  an  attempt  was  made  experimentally  to  apply 
this  idea  in  treating  a  number  of  cases.  The  results  have 
been  good,  and  while  it  is  admitted  that  there  are  several 
fundamental  classes  of  prostatic  hypertrophy  (as  those  due 
to  a  latent  infection  or  to  a  new  growth)  which  should  not 
be  expected  to  respond  to  this  measure,  there  are  pretty 
good  chances  of  getting  some  satisfactory  results  from 
using  Leydig  Cell  Co.  (Harrower).  The  dose  is  one,  four 
times  a  day,  later  increased,  if  it  seems  advisable,  to  two, 
three  times  a  day. 

12.     THYROID  ENLARGEMENT  IN  GIRLS 

Query:  "From  time  to  time  I  have  a  number  consulting 
me  about  glandular  enlargement  of  the  neck.  They  are 
usually  in  the  late  teens  or  early  twenties,  and  I  am  won- 
dering if  it  is  connected  with  ovarian  dysfunction." 

Answer:  The  thyroid  gland  is  very  definitely  related  to 
ovarian  function.  Often  the  ovarian  hormonic  activ- 
ities are  not  normal  and  the  thyroid  gland  has  a  heavier 
burden  to  perform,  which  occasionally  causes  an  increase  in 
its  size.  This  is  one  of  the  reasons  for  the  quite  common 
enlargement  of  the  thyroid  in  girls  at  puberty.  It  will  be 
recalled  that  the  thyroid  gland  often  enlarges  in  the  early 
part  of  pregnancy,  and  this  may  be  due  to  two  causes :  First, 
the  effort  of  the  thyroid  gland  to  reestablish  a  function 
which  it  presumes  has  become  insufficient  from  some  abnor- 
mal reason  when  in  reality  the  temporary  ovarian  insuf- 
fiency  of  pregnancy  is  normal.  Second,  the  thyroid  gland 
is  an  important  part  of  the  detoxicating  mechanism  of  the 
body,  and  there  is  naturally  an  increase  in  the  toxemia  dur- 
ing pregnancy,  and  the  thyroid  gland  has  to  enlarge  itself 
to  accomplish  the  added  work  that  it  is  called  upon  to  do. 

There  is  still  another  form  of  enlargement  of  the  thyroid 
which  is  not  so  definitely  connected  with  the  age  or  sex  of 
the  patient,  and  which,  of  course,  is  due  to  poisoning  or 
toxemia.  In  these  cases  the  enlargement  of  the  neck  is  due 
to  irritation  of  the  gland,  and  the  condition  is  an  entirely  dif- 
ferent one  from  the  former. 

In  the  thyroid  enlargement  of  ovarian  origin,  thyroid 
extract  is  useful,  but  combinations  of  thyroid  and  ovarian 


358  PRACTICAL   ORGANOTHERAPY 

extracts  are  very  much  more  useful  merely  because  the 
enlargement  is  a  manifestation  of  a  pluriglandular  func- 
tion rather  than  connected  solely  with  a  disturbance  of  the 
gland  itself. 

My  Thyroid  Function  Test,  which  is  very  easily  applied, 
will  enable  one  to  differentiate  between  conditions  of  thy- 
roid apathy  and  thyroid  sensitiveness,  and  if  there  is  thy- 
roid apathy  it  is  very  easy  to  connect  it  with  ovarian  dys- 
function by  the  clinical  findings  and  symptoms  and  to  treat 
the  symptom-complex  from  a  pluriglandular  standpoint  as, 
for  example,  with  Thyro-Ovarian  Co.  (Harroiver). 

The  most  important  point  to  bear  in  mind  in  regard  to 
thyroid  disorders  in  girls  is  the  compensatory  relationship 
between  the  endocrine  glands.  If  this  is  remembered,  the 
pluriglandular  aspects  of  these  cases  will  be  more  promi- 
nent and  better  appreciated,  and  the  chances  for  a  satisfac- 
tory outcome  are  multiplied  many  times. 


13.    FAILURES  WITH  ADRENAL  SUPPORT 

Query:  "I  have  used  your  Adreno-Spermin  Co.  in  per- 
haps thirty  cases,  and  have  come  to  depend  on  it  as  a  fine 
tonic  in  what  you  call  'the  run-down  cases.'  During  the 
past  few  weeks  I  have  encountered  two  cases,  one  a  man, 
and  the  other  a  woman,  both  around  the  fifty  mark,  who 
did  not  respond  in  the  expected  manner.  In  fact,  so  far  as 
I  could  see,  it  did  no  good  whatever,  and  I  was  much  dis- 
appointed. Can  you  tell  me  the  reason  for  this?" 

Answer:  I  am  glad  you  have  had  enough  experience  with 
this  formula  to  have  been  convinced  that  it  is  indeed  ef- 
fective. If  you  had  run  across  these  unsatisfactory  cases 
at  first,  you  might  have  been  tempted  to  question  this  whole 
method.  But  you  have  found  out  that  there  is  decided  merit 
for  supporting  the  adrenal  system ;  and  that  through  these 
glands  it  is  possible  to  increase  oxidation,  stimulate  the  cir- 
culatory apparatus,  raise  lowered  blood-pressure  and  in- 
crease the  "pep." 

If  you  will  read  "Failures  With  Organotherapy,"  in  my 
book,  "PRACTICAL  ORGANOTHERAPY/'  you  will  find  several 
good  reasons  for  occasional  failures.  The  first  thought  that 
conies  to  me  concerns  the  cause  of  the  difficulty  you  have 
been  treating — might  it  not  be  that  the  cause  still  remains, 
and  that  the  continued  adrenal  depletion  is  more  than  the 
advantage  that  any  adrenal  support  may  accomplish  ?  Again, 
in  my  experience,  the  greatest  source  of  failure  from  the 


COLD  HANDS  AND  FEET  359 

organotherapy  of  chronic,  intractable  cases  is  the  indeter 
minate  responsiveness  of  the  endocrine  glands  it  is  desired 
to  encourage.  In  many  cases  the  removal  of  toxemia,  etc., 
and  the  use  of  Adreno-Spermin  Co.  (Narrower)  for  a 
couple  of  weeks  or  more,  reestablishes  adrenal  function  and 
all  is  fine.  If,  however,  the  adrenals  are  fagged  out  and 
are  unable  to  respond  to  the  gentle  encouragement  thus 
offered,  it  is  clear  that  the  results  will  not  be  especially 
good,  or  at  least  not  as  rapid  as  in  a  more  responsive  case. 
Here,  indeed,  is  the  great  difficulty  in  all  forms  of  organo- 
therapy. We  depend  almost  entirely  upon  the  reactivity  of 
the  glands  it  is  intended  to  stimulate.  If  they  are  not  CP- 
pable  of  accepting  these  stimuli,  or  their  powers  of  picking 
up  the  waiting  hormones  in  the  blood  are  reduced,  it  is  clear 
that  the  results  cannot  be  so  quick  nor  so  good. 

Fortunately  you  are  already  converted ;  but  had  you  not 
been  by  perhaps  28  good  experiences,  I  can  readily  see  how 
easy  it  would  be  for  you  to  say — "More  bunk.  This  man, 
Harrower,  is  claiming  too  much  for  his  stuff — as  usual!" 
As  a  matter  of  fact,  this  is  not  "bunk,"  nor  am  I  a  bit  too 
enthusiastic  about  the  immense  possibilities  of  adrenal  sup- 
port in  a  large  class  of  cases. 

Don't  forget  that  occasionally  other  forms  of  treatment, 
known  to  be  effective  hundreds  of  times  before,  have  failed 
altogether,  much  to  our  chagrin.  We  expect  this  occasion- 
ally from  our  formulas,  and  if  you  can  make  your  success- 
ratio  28  to  2  or  approximately  93  per  cent,  you  ought  to 
be  as  pleased  as  I  would  be  myself. 


14.     ENDOCRINE  ASPECTS  OF  COLD  HANDS  AND 

FEET 

Query:  "Will  you  kindly  clarify  a  few  of  the  statements 
which  I  have  run  across  in  your  articles  relative  to  the 
diagnosis  and  organotherapeutic  treatment  in  high  blood- 
pressure  and  hypoadrenia  in  particular? 

"In  your  brochure  on  Adrenal  Support,  you  remark  that 
cold  hands  and  feet  are  symptomatic  of  the  asthenia  of 
hypoadrenia,  and,  per  contra,  in  your  interesting  article, 
'Hypothyroidism,  Infiltration  and  Hypertension/  published 
in  a  recent  issue  of  the  New  York  Medical  Record  (Nov. 
20,  1920) ,  you  likewise  credit  cold  hands  and  feet  as  being 
symptoms  of  that  affection  also.  The  first  condition  you 
ascribe  to  the  poor  circulation  attendant  upon  low  blood- 
pressure,  etc.,  and  the  other  to  ischemia  of  those  particular 
parts,  resulting  from  pressure  on  the  precapillary  areas  of 


360  PRACTICAL  ORGANOTHERAPY 

those  parts  by  infiltrated  cells  surrounding  those  areas,  both 
of  which  ideas  seem  to  me  to  be  pathologically  correct. 

"Accordingly,  cold  hands  and  feet  are  symptoms  both 
of  low  and  of  high  blood-pressure,  which  means  that  they 
are  not  pathognomonic  of  either  state.  Now,  if  a  patient 
should  call  at  my  office,  complaining  of  cold  hands  and  feet, 
I  would  have  to  think  of  both  conditions — high  and  low  ten- 
sion— and  infer  from  other  attendant  symptoms  which  of 
the  two  conditions  I  have  on  hand.  Therefore,  this  par- 
ticular symptom  will  not  materially  aid  me  in  the  diagnosis 
of  that  case. 

"You  stated  at  the  same  time  that  thyroid  extract  is  fre- 
quently indicated  in  cases  of  hypertension.  If  so,  and  thy- 
roid is  given  to  those  cases  in  your  formula,  for  example, 
Thyro-Pancreas  Co.  with  Spermin,  and  you  also  suggest 
thyroid  in  the  treatment  of  low  blood-pressure  and  asthenia, 
which  preparation  likewise  is  also  incorporated  in  your 
preparation,  Adreno-Spermin  Co.,  and  which  is  used  for 
an  entirely  different  thing,  accordingly,  I  should  judge  that 
thyroid  gland  is  beneficial  in  both  high  and  low  blood- 
pressure  states.  How  do  you  reconcile  these  facts  ?" 

Answer:  You  are  a  very  careful  reader  of  what  I  write, 
and  so  I  shall  attempt  to  give  careful  attention  to  your 
query,  because  I  see  that  it  is  not  an  attempt  to  "bawl 
me  out,"  nor  is  it  an  attempt  to  offer  criticism  for  my  mak- 
ing two  statements,  which  seem  to  be  entirely  opposite,  but 
is  a  frank  effort  to  call  my  attention  to  seeming  discrepan- 
cies and  to  acquire  further  information,  which  you  may 
be  able  to  use.  I  recall  that  you  have  written  me  before 
along  similar  lines,  and  have  asked  questions,  which  have 
illuminated  both  of  our  therapeutic  paths,  and  therefore, 
I  am  very  glad  to  go  into  this  matter  much  more  fully  than 
I  otherwise  might  do. 

To  begin  with,  there  is  no  denying  the  fact  that  in  asthe- 
nia with  low  blood-pressure,  poor  elimination,  and,  particu- 
larly, adrenal  insufficiency,  there  is  a  tendency  to  circu- 
latory stasis  and,  consequently,  cold  hands  and  feet.  This 
is  always  found  in  adrenal  insufficiency,  where  the  circu- 
latory aspects  of  the  case  are  at  all  marked.  You  will 
recall  that  these  patients  very  often  have  a  subnormal  tem- 
perature as  well.  You  will  find  this  particular  symptom 
in  various  degrees  of  adrenal  insufficiency.  The  post- 
influenzal  hypoadrenia,  which  has  been  such  a  terrible  bur- 
den upon  the  profession  following  the  epidemic  of  a  few 
years  ago,  is  very  commonly  associated  with  a  complex 


COLD  HANDS  AND  FEET  361 

syndrome  in  which  circulatory  inequality  and  cold  hands 
and  feet  are  common.  This,  I  believe  to  be  due  to  hy- 
poadrenia.  As  you  will  shortly  see,  however,  it  is  not  neces- 
sarily solely  due  to  this. 

In  my  article  published  in  the  Medical  Record,  I  called 
attention  to  a  fact  which  I  had  not  previously  seen  in  the 
literature,  viz.,  the  principle  relating  hypothyroidism  with 
high  blood-pressure  when  there  is  a  marked  cellular  infil- 
tration resulting  from  the  hypothyroidism.  You  have  very 
accurately  stated  this  in  few  words,  when  you  say,  "The 
other  is  due  to  ischemia  of  those  parts  resulting  from  pres- 
sure on  the  precapillary  areas  of  those  parts  by  infiltrated 
cells  surrounding  those  areas,  both  of  which  [conditions] 
seem  to  me  to  be  pathologically  correct."  Now  it  is  also 
equally  true,  when  thyroid  insufficiency  causes  cellular  lazi- 
ness, and  this  in  turn  causes  the  infiltration  which  is  path- 
ognomonic  of  myxedema  or  of  the  minor  forms  of  thyroid 
insufficiency,  that  this  infiltration  would  impede  the  capil- 
lary circulation,  and  it  does  so  absolutely;  consequently  in 
hypothyroidism  there  is  a  circulatory  complex  which  causes 
cold  hands  and  feet  and,  of  course,  this  is  the  rule,  for  this 
is  one  of  the  typical  findings  in  hypothyroidism,  and  not 
merely  are  the  extremities  cold,  but  the  whole  body  is 
cold,  the  patient  is  cold,  and  the  circulation  is  impeded  very 
materially.  As  a  matter  of  fact,  this  aspect  of  such  cases 
is  sometimes  the  first  thing  which  calls  our  attention  to  the 
inactivity  of  the  thyroid. 

Hence,  it  is  perfectly  true  that  while  hypoadrenia  may 
cause  cold  hands  and  feet;  so  does  hypothyroidism.  And, 
Doctor,  hypocrinism  is  the  rule  and  this  is  a  pluriglandular 
endocrine  insufficiency  in  which  the  thyroid  and  the  adre- 
nals certainly  are  related  and  probably  other  glands  with 
them.  In  other  words,  when  you  have  a  hypoadrenia  you 
usually  have  hypothyroidism,  and  when  you  have  hypothy- 
roidism it  is  the  most  natural  thing  in  the  world  for  the 
inactive  chemistry  to  bring  about  a  condition  of  toxemia, 
which  depletes  the  adrenal  glands  and  consequently  causes 
hypoadrenia.  This  means  that  cold  hands  and  feet  are  typ- 
ical findings  in  cases  of  either  hypoadrenia  or  hypothyroid- 
ism, or  both  together. 

Now  for  your  well-meant  criticism  about  the  apparent 
discrepancy  between  the  recommendations  in  the  treatment 
of  these  cases.  Thyroid  is  included  in  the  Thyro-Pancreas 
Co.  with  Spermin,  because  of  its  value  as  a  means  of  stimu- 
lating cellular  chemistry,  reducing  the  infiltration  which 


362  PRACTICAL   ORGANOTHERAPY 

may  be  present,  and  thereby  permitting,  mechanically  at 
least,  as  well  as  in  other  ways,  I  believe,  an  increase  in 
chemistry  and  circulation.  Thyroid  is  recommended  as  a 
remedy  for  high  blood-pressure  for  another  reason,  viz., 
it  favors  detoxication  and  therefore  lessens  the  very  fac- 
tors which  are  believed  to  irritate  the  pressor  mechanism. 

Thyroid  is  also  found  in  Adreno-Spermin  Co.  (Harrower) 
which  is  used  in  hypoadrenia  with  low  blood-pressure, 
poor  elimination  of  wastes  and  especially  urea,  and  the 
marked  asthenic  and  neurasthenic  conditions  so  common 
in  chronic  cases,  and  is  included  in  this  remedy  because, 
as  we  have  seen,  hypoadrenia  so  commonly  involves  the 
thyroid  and  the  two  insufficiencies  go  together.  When  a 
person  is  all  played  out  as  a  result  of  some  toxemia  or  other 
condition,  he  requires  not  merely  adrenal  support,  but  an 
encouragement  to  the  cellular  chemistry  which,  as  you 
know,  is  presided  over  by  the  thyroid,  and  consequently 
small  doses  of  thyroid  are  equally  valuable  as  an  adjuvant 
to  adrenal  substance  and  other  similar  remedies  for  the 
treatment  of  hypoadrenia  and  run-down  conditions  gen- 
erally. 

Your  deduction  that  thyroid  may  be  beneficial  in  both 
high  and  low  blood-pressure  is  correct,  and  it  is  when  there 
is  a  hypothyroidism  underlying  it.  Thyroid  alone  is  more 
likely  to  reduce  high  blood-pressure,  which  is  due  to  this 
infiltration,  because  of  the  mechanical  influence  already 
referred  to.  On  the  other  hand,  thyroid  alone  may  raise 
blood  pressure  provided  conditions  are  such  that  the  en- 
couragement of  oxidation  removes  or  lessens  toxemia,  which 
in  turn  releases  the  adrenal  glands  and  permits  them  to 
regain  a  certain  amount  of  their  normal  function  and  there- 
fore increase  the  efficacy  of  the  circulatory  mechanism  and, 
consequently,  the  blood  pressure.  As  a  matter  of  fact,  thy- 
roid extract  is  not  given  for  its  benefit  in  hypertension  or 
in  hypotension,  but  rather  for  its  influence  upon  the  en- 
docrine glands,  which  are  responsive  to  these  factors  and 
which  may  be  connected  with  either  the  one  or  the  other 
of  these  conditions. 

In  a  previous  communication  I  have  referred  to  "the 
condiment  influence  of  thyroid  gland."  This  is  another 
reason  why  it  is  included  in  these  formulas,  because,  for 
some  reason  or  another,  a  pluriglandular  formula  which 
contains  a  small  amount  of  thyroid  is  very  much  more  effi- 
cient therapeutically  than  where  no  such  addition  is  made. 

I  do  not  know  whether  I  may  have  reconciled  these  facts 


DEMINERALIZATION  363 

to  your  satisfaction,  but  I  do  know  this,  that  clinically  the 
use  of  thyroid  in  suitable  cases  will  increase  the  chemistry 
of  the  body  sufficiently  to  reduce  infiltration,  which  may  be 
due  to  myxedema,  or  myxedeme  fruste,  or  to  a  minor  hy- 
pothyroidism.  It  will  also  increase  oxidation  and  reduce 
those  factors  which  irritate  (and  later  deplete)  the  adrenal 
glands ;  and  where  these  indications  are  clear,  the  indicated 
organotherapy  is  useful,  no  matter  whether  the  results 
seem  to  be  opposite  to  one  another  or  not. 

I  am  glad  to  be  able  to  subjoin  here  a  part  of  the  answer 
to  this  interesting  correspondence : 

"Your  favor,  enclosing  the  manuscript  embodying  the 
questions  I  propounded  to  you,  and  your  answers  to  same, 
is  before  me.  Your  explanation  elucidating  the  influences 
that  both  hypoadrenia  and  hypothyroidism  exert  upon  the 
causation  of  'cold  hands  and  feet*  is  exceedingly  clear  and 
convincing,  and  the  best  explanation  you  or  anybody  else 
has  advanced  so  far.  I  fully  concur  with  your  views. 

"Your  reasons  for  incorporating  thyroid  extract  in  your 
Thyro-Pancreas  Co.  on  account  of  its  influence  in  reduc- 
ing cellular  infiltration  in  (Barker's)  precapillary  areas  and 
thereby  reducing  blood  pressure,  likewise  its  combination 
with  adrenal  substance  (in  your  Adreno-Spermin  Co.)  for 
its  influence  in  increasing  oxidation  and  thereby  promoting 
the  eliminaton  of  toxins,  and  giving  the  adrenals  a  much- 
needed  rest,  and  thus  raising  lowered  blood-pressure,  which 
you  correctly  ascribe  to  hypoadrenia,  are  also  transcend- 
«ntly  plausible  and  convincing.  This  leaves  no  doubt  in  my 
mind  as  to  why  thyroid  is  efficacious  in  both  high  and  low 
blood-pressure  states." 


15.    DYSCRINISM  AND  DEMINERALIZATION 

Query:  "Is  endocrine  dysfunction  due  to  mineral  de- 
ficiency, or  is  the  mineral  deficiency  due  to  improper  func- 
tioning of  the  ductless  glands  ?" 

Answer:  Very  briefly,  the  answer  to  this  important 
question  is  that  endocrine  dysfunction  favors  mineral  de- 
ficiency because  of  the  slowed  and  disturbed  chemistry  re- 
sulting from  the  lessened  hormone  stimuli  which  are  neces- 
sary to  maintain  metabolism  at  its  proper  rate.  The  wastes 
which  are  not  fully  oxidized  are  many  of  them  of  an  acid 
nature  and  tend  to  neutralize  the  body's  reserve  of  alkaline 
salts  and  bring  about  the  condition  which  the  French  have 
called  demineralization.  Just  as  soon  as  there  is  a  deficiency 


364  PRACTICAL   ORGANOTHERAPY 

in  this  alkaline  mineral  reserve  a  further  improper  func- 
tioning of  the  ductless  glands  is  favored.  In  some  instances 
they  may  be  irritated  by  these  poisons,  but  in  most  cases 
their  function  is  lessened — they  are  overburdened.  It  is 
difficult  to  determine  just  when  cause  becomes  effect,  and 
vice  versa;  but  an  insufficient  activity  of  the  endocrine 
glands  and  demineralization,  or  a  lessening  of  the  body's 
reserve  of  alkaline  salts,  are  intimately  related  to  one  an- 
other, and  from  a  clinical  standpoint,  should  be  considered 
simultaneously. 


16.     ORGANOTHERAPY  FOR  CANCER 

Query:  Please  send  me  literature  and  other  information 
on  your  remedy  for  cancer." 

Answer:  We  have  no  remedy  for  cancer.  I  am  not  aware 
that  organotherapy  can  be  of  any  particular  value  in  the 
treatment  of  cancer,  though,  of  course,  it  is  possible  and, 
for  that  matter,  very  probable  that  patients  with  cancer 
have,  accompanying  the  actual  cancerous  growth,  a  dis- 
turbed function  of  the  glands  of  internal  secretion  which, 
with  certain  limitations,  may  respond  to  organotherapy. 

For  example:  I  know  a  case  of  carcinoma  of  the  uterus 
in  whom  there  was  a  very  serious  and  foul-smelling  dis- 
charge from  the  vagina.  This  was  controlled  entirely  by 
means  of  MammctrPituitary  Co.  (Harrower),  a  formula? 
which  we  ordinarily  use  for  the  treatment  of  menorrhagia 
and  as  a  pelvic  depletant.  I  had  some  difficulty  in  convinc- 
ing the  doctor  that  this  was  not  going  to  make  any  notice- 
able difference  in  the  actual  cancer  and,  of  course,  I  do  not 
suppose  it  did,  although  I  have  lost  track  of  the  case.  The 
fact  remains  that  organotherapy  was  efficacious  in  an  en- 
couraging way  in  this  instance. 

Practically  every  case  of  cancer  is  "cachectic."  Cachexia 
is  nothing  in  the  world  but  a  toxemic  malnutrition  and  one 
cannot  have  a  condition  of  this  kind  without  a  serious  de- 
pletion of  the  glands  of  internal  secretion.  Cancerous  pa- 
tients are  invariably  asthenic.  They  have  very  poor  elim- 
ination. They  are  usually  suffering  from  a  typical  syn- 
drome of  adrenal  insufficiency,  and,  consequently,  are  in 
need  of  treatment  of  the  character  that  we  call  adrenal 
support,  and  which  is  discussed  quite  fully  elsewhere.  How- 
ever, this  is  not  treatment  for  the  cancer,  but  rather  for 
the  serious  endocrine  depletion  which  results  from  the  tox- 
emia accompanying  the  cancer. 


OVARIAN  THERAPY  365 

17.     ABDOMINAL  PAIN  FOLLOWING   OVARIAN 

THERAPY 

Query:  "In  two  cases  of  dysovarism — as  to  the  diagnosis 
of  which  I  feel  quite  positive — there  has  been  quite  a  little 
pain  in  the  lower  abdomen  and  slight  nausea  following  the 
administration  of  the  Thyro-Ovarian  formula.  I  should 
be  pleased  to  hear  from  you  with  any  suggestion  at  your 
earliest  convenience." 

Answer:  Ovarian  therapy,  as  we  all  know,  is  useful  for 
its  homo-stimulant  effect;  that  is  to  say,  it  encourages  the 
functional  activity  of  the  ovaries  in  the  same  way  that 
thyroid  extract  encourages  thyroid  activity  and  adrenal 
substance  encourages  adrenal  activity.  One  of  the  uniform 
findings  following  the  administration  of  a  glandular  ex- 
tract for  this  homo-stimulative  influence  is  an  increased 
circulation  and  sometimes  even  an  hypertrophy.  It  will 
be  recalled  that  in  his  "law"  Professor  L.  Hallion,  of  Paris, 
makes  the  following  remark  (note  especially  the  part  that 
is  in  italics)  : 

"Extracts  of  an  organ  exert  upon  the  same  organ  an  ex- 
citing influence  which  lasts  for  a  longer  or  shorter  time. 
When  an  organ  is  insufficient,  it  is  conceivable  that  this  in- 
fluence augments  its  action,  and,  when  it  is  injured  that  it 
favors  its  restoration." 

I  have  had  many  clinical  experiences  which  indicated  to 
me  that  there  was  an  increased  circulation  and  functional 
activity  of  the  ovary  following  a  suitable  period  of  ovarian 
organotherapy,  and  it  is  this  increased  circulation  or 
physiological  congestion  which  is  likely  to  be  the  cause  of 
the  pain.  The  pain,  I  believe,  may  be  due  to  the  fact  that 
the  ovary  itself  is  structurally  disturbed  or  deranged  and 
that  its  capsule  has  become  thickened  and  sclerotic  so  that 
any  engorgement  or  enlargement  ever  so  slight,  stretches 
this  thickened  and  elastic  covering,  thus  causing  pain.  Nat- 
urally we  have  an  organic  condition  to  deal  with  here,  and 
while  there  is  undoubtedly  a  functional  one  in  these  ova- 
rian cases,  organotherapy  does  not  soften  the  sclerotic  ova- 
rian capsule  nor  does  it  make  it  more  elastic.  This  en- 
gorgement is  necessary  to  increase  the  function  of  the 
inactive  glands ;  and  in  these  cases  evidently  we  really  have 
two  distinct  evils  to  contend  with. 

As  a  matter  of  fact,  when  we  find  an  ovarian  dysfunc- 
tion of  an  organic  type  with  a  sclerotic  capsule,  ovarian 
cysts  or  other  organic  changes  in  or  around  the  ovary,  sur- 


366  PRACTICAL   ORGANOTHERAPY 

gery  is  about  all  we  can  do,  provided  we  cannot  modify  the 
function  by  means  of  suitable  organotherapy.  I  have  run 
across  experiences  of  this  type  several  times,  in  two  of 
which  an  operation  was  performed  and  the  presumed  con- 
dition was  found  to  be  really  present,  and  the  ovary  was 
"decapsulated"  with  considerable  benefit. 

Fortunately  this  does  not  occur  very  often,  but  I  trust 
that  it  is  a  reasonable  explanation  of  the  condition  that 
you  find  and  that  you  may  have  very  few  cases  like  this 
in  the  future. 


18.   MENTAL  DETERIORATION  FOLLOWING  A 
FRIGHT 

Query:  "Have  you  had  any  experience  in  your  therapy 
with  mental  deterioration  following  severe  fright  or  shock? 
I  have  a  little  fellow  of  six,  who  is  claimed  to  have  been 
perfectly  normal  up  to  the  age  of  four,  talking,  walking, 
etc.  At  that  time  he  received  a  severe  fright,  and  con- 
sequent nervous  shock,  which  is  said  to  be  the  cause  of 
his  suddenly  losing  his  speech  and  gradually  deteriorating. 
He  is  a  very  nervous,  reckless  child,  with  poor  compre- 
hension and  concentration.  What  would  you  suggest  along 
your  line?" 

Answer:  Not  having  had  a  case  of  this  type  I  referred 
this  query  to  my  friend,  Dr.  E.  Bosworth  McCready,  of 
Pittsburgh,  whose  work  with  developmentally  defective 
children  is  of  a  very  high  order,  and  he  wrote  me  as  fol- 
lows: 

"It  has  been  my  good  fortune  to  see  a  number  of  cases 
presenting  a  history  somewhat  similar  to  the  one  you  men- 
tion. Some  of  these  were  cases  of  congenital  lues,  in  which 
the  fright  for  some  unknown  reason  seemed  to  cause  to 
develop  what  practically  amounted  to  a  psychosis;  others 
showed  a  markedly  increased  intracranial  pressure,  and  on 
cranial  decompression  signs  of  hemorrhage  or  a  mild 
meningo-encephalitis.  One  case,  not  due  to  mental  stress, 
but  to  a  convulsion  following  the  ingestion  of  egg  in  a  sen- 
sitized child,  also  showed  evidence  of  hemorrhage  on  opera- 
tion. All  of  my  cases  have  showed  a  'splitting  off'  of  per- 
sonality, and  I  can  conceive  of  the  same  thing  happening 
in  an  anemic,  hypoplastic  child  without  the  occurrence  of 
an  actual  organic  lesion,  though  I  do  not  believe  this  often 
happens.  Organotherapy  helps  after  the  cause  has  been 
removed  or  counteracted;  but  is  almost  useless  before." 


PLURIGLANDULAR  THERAPY  367 

If  organotherapy  is  attempted  in  such  a  case,  I  would 
suggest  the  usual  pluriglandular  formula  for  hypoplastic 
and  backward  children — Antero-Pituitary  Co.  (Narrower) 
— and  so  far  as  I  can  see,  no  harm  can  come  from  applying 
this  whilst  further  study  and  other  treatment  (for  the 
suggested  lues  or  local  intracranial  condition)  is  going  on. 

19.    DISCREPANCIES  IN  PLURIGLANDULAR 
THERAPY 

Query:  "Cannon,  in  his  work  on  the  autonomic  nervous 
system,  has  divided  it  into  three  parts :  1.  Cranial,  2.  Thor- 
acic Lumbar,  3.  Sacral.  Nos.  1  and  3  make  up  what  is 
commonly  known  as  the  'vagus/  while  No.  2  is  known  as  the 
'sympathetic'  and  the  effect  of  stimulation  of  one  is  ex- 
actly opposed  to  that  of  the  other. 

"In  the  Department  of  Experimental  Therapeutics  of 
Cornell  Medical  College  (see  Medical  Record,  Oct.  16,  1920) 
it  has  been  demonstrated  that  the  thyroid  is  a  'vagus 
stimulator'  and  that  the  adrenals  are  'sympathetic  stimu- 
lators/ So  far  as  some  of  your  formulas  are  concerned 
it  seems  to  me  like  giving  an  acid  and  an  alkali  together. 
If  both  these  sets  of  nerves  need  toning  up,  it  strikes  me 
that  it  would  be  better  to  alternate  either  doses  or  days 
in  the  week. 

"In  view  of  the  research  work  quoted  I  think  this  for- 
mula neutralizes  itself  more  or  less." 

Answer:  The  work  quoted  above,  and  sponsored  by  Can- 
non and  other  investigators,  is  based  upon  splendid  experi- 
mental studies  and  good  reasoning.  This  position  is  ac- 
cepted by  practically  all  of  the  medical  profession,  and  I 
believe  that  it  is  correct. 

At  the  Mayo  Clinic  some  work  recently  has  been  done 
indicating  that  the  thyroid  encourages  the  vagus,  and  the 
experimental  work  done  at  Cornell  mentioned  above  em- 
phasizes this.  It  is  well  known  that  the  adrenal  glands 
stimulate  the  sympathetic.  However,  I  am  not  willing  to 
admit  that  the  administration  of  thyroid  and  adrenal  sub- 
stance is  akin  to  "giving  an  acid  and  an  alkali  together." 
They  do  not  neutralize  one  another  and  their  function  is 
extended  very  much  further  than  their  incidental  influence 
upon  the  various  divisions  of  the  autonomic  nervous  system. 

I  admit  that  it  seems  like  a  discrepancy  to  offer  an  indi- 
vidual a  vagus  stimulator  in  conjunction  with  a  sympa- 
thetic stimulator ;  but  what  about  the  content  of  the  normal 


368  PRACTICAL   ORGANOTHERAPY 

blood  which  reaches  these  various  organs  or  parts  of 
organs?  Does  not  this  contain  all  the  hormones  and  the 
various  other  chemical  substances  in  solution  or  suspen- 
sion? Does  not  the  same  drop  of  blood  which  happens  to 
be  passing  through  a  given  part  of  the  body  contain  just 
as  many  anti-hormones  as  hormones,  or  vagus  stimulators 
as  sympathetic  stimulators? 

The  great  point,  as  I  see  it,  is  fully  explained  in  the 
theory  or  hypothesis  which  I  enunciated  some  years  ago, 
(see  "A  Hypothesis  of  Hormone  Hunger" — N.  Y.  Medical 
Record,  1919,  xcvi,  276).  This  idea  is  based  upon  good 
reasoning  although  I  do  not  think  it  can  be  proved  scien- 
tifically. The  facts  are  that  the  blood  which  goes  to  a  given 
organ  contains  all  these  various  substances  in  it,  and  the 
organ  that  is  to  be  influenced  exerts  a  wonderfully  wise 
and  subtle  selective  capacity,  and  my  contention  is  that  not 
merely  is  this  true,  but  that  the  selective  capacity  is  modi- 
fied by  the  need  of  that  given  organ  for  the  hormone  stim- 
uli. In  other  words,  the  greater  the  need,  the  greater  avid- 
ity with  which  these  substances  are  snatched  from  the 
blood  as  it  passes  by. 

Now  to  come  back  to  the  possibility  that  pluriglandular 
therapy  of  the  type  mentioned  "neutralizes  itself  more  or 
less."  In  an  individual  who  has  the  symptom-complex  which 
in  our  estimation  calls  for  stimulation  by  means  of  thyroid 
as  well  as  through  the  adrenal  glands,  the  hyppthyroidism 
has  brought  about  a  certain  combination  of  conditions  which 
will  be  benefited  only  by  giving  the  system  the  thyroid  that 
it  needs  so  much;  and  the  asthenic  syndrome  in  which 
hypoadrenia  predominates  requires  adrenal  support  just  ex- 
actly as  the  other  condition  requires  thyroid  support.  It  is 
surely  well  known  that  these  two  conditions  fit  in  together 
and  that  hypoadrenia  is  very  common  in  conjunction  with 
hypothyroidism,  and  vice  versa.  Clinical  experience  estab- 
lishes this,  and  the  best  proof  of  the  reasonableness  of  the 
attitude  which  I  have  been  emphasizing  for  many  years  is 
the  clinical  advantage  rather  than  the  theoretical  reason- 
ableness. 

I  think  that  it  could  be  established  theoretically  that 
hypothyroidism  and  hypoadrenia  naturally  should  go  to- 
gether, and  that  the  administration  of  a  pluriglandular 
formula  directed  at  both  of  these  together  certainly  renders 
a  much  broader  service  than  to  attack  the  one  or  the  other 
singly.  If  at  the  same  time  the  vagus  is  stimulated  by 
one  part  of  the  formula  and  the  sympathetic  by  another 


PELLAGRA  369 

part  of  the  formula,  the  degree  of  these  respective  stimuli 
depends  entirely  upon  the  body's  receptivity  of  these  sub- 
stances, and  not  upon  pur  own  will.  As  a  matter  of  fact, 
our  will  to  render  service  to  a  patient  is  dependent  entirely 
upon  this  endocrine  receptivity,  and  this  is  one  of  the  chief 
factors  in  determining  how  valuable  organotherapy  is  going 
to  be  in  a  given  case — the  responsiveness  of  these  organs  is 
the  fundamental  factor  in  determining  its  usefulness. 

I  am  convinced,  no  matter  whether  certain  substances 
stimulate  the  vagus  and  others  stimulate  the  sympathetic, 
that  when  given  together  the  general  tone  imparted  to  both 
the  vagus  and  the  sympathetic  is  an  advantage  as  well  as 
the  resultant  encouragement  of  the  associated  glands  as  a 
whole. 

In  so  far  as  the  suggestion  to  give  these  various  differ- 
ing preparations  a  part  of  the  time  and  alternating  them 
is  concerned,  I  do  not  think  this  is  good  advice  because 
if  indeed  the  body  has  selective  capacity  enough  to  deter- 
mine its  needs  along  these  lines,  then  this  is  present  and 
useful  during  each  of  the  two  differing  times,  i.  e.,  during 
the  time  that  we  are  giving  the  one  formula  and  the  alter- 
nating time  during  which  we  might  be  giving  the  other. 

This  correspondent's  suggestion  may  seem  to  bring  up  a 
discrepancy  in  the  fundamentals  of  pluriglandular  therapy, 
but  too  much  water  has  passed  under  the  bridge  and  too 
many  experiences  have  established  the  reasonableness  of 
considering  pluriglandular  conditions,  and  particularly 
hypothyroidism  and  hypoadrenia  together,  to  make  me  want 
to  change  my  attitude  just  because  of  some  seeming 
theoretical  disagreement. 


20.    AN  ENDOCRINE  ASPECT  OF  PELLAGRA 

Question:  "I  am  asking  for  information  regarding  a 
case  of  pellagra.  The  patient  complains  of  lack  of  concen- 
tration, is  easily  irritated,  and  the  mental  condition  is  very 
sluggish.  There  should  be  some  possibilities  of  organo- 
therapy in  a  case  like  this,  should  there  not?" 

Answer:  So  far  as  I  know  there  is  nothing  in  organo- 
therapy that  can  definitely  interfere  with  the  pellagra  itself. 
That  is  to  say,  the  causative  condition  is  not  amenable  to 
endocrine  treatment,  but  it  is  very  clear  from  all  that  I  have 
heard  and  read  about  pellagra  (and,  by  the  way,  quite  a 
number  of  physicians  have  been  kind  enough  to  express 
their  opinions  about  the  use  of  our  products  in  the  treatment 

24 


370  PRACTICAL   ORGANOTHERAPY 

of  pellagra),  that  undoubtedly  there  is  an  endocrine  aspect 
to  this  infection,  just  as  there  is  to  many  other  infections. 

Your  patient  complains  of  lack  of  concentration,  a  slug- 
gish mental  condition,  and  the  emotional  aspects  of  the  case 
show  an  irritability.  Every  one  of  these  conditions  is  closely 
related  to  the  sympathetic  nervous  system,  to  the  endocrine 
glands,  and  to  the  detoxicating  mechanism  of  the  body. 

Organotherapy  directed  at  such  conditions  is  likely  to  be 
of  benefit,  but  you  can  readily  understand  that  it  will  not 
reach  the  underlying  difficulty.  The  pellagra  must  be 
treated  in  the  accepted  manner,  and  where  the  evidences  of 
an  endocrine  imbalance  are  also  present,  as  they  are  in 
many  cases,  then  organotherapeutic  interference  would  be 
worth  while. 

To  my  way  of  thinking,  one  of  the  best  things  that  could 
be  done  in  an  individual  of  this  type,  would  be  to  give  a 
Thyroid  Function  Test  first.  Do  not  forget  that  the  symp- 
toms mentioned  in  your  inquiry  are  also  the  symptoms  of 
hypothyroidism.  If  this  patient  also  has  a  low  blood-pres- 
sure, a  very  limited  circulatory  tone,  subnormal  tem- 
perature, and  the  elimination  of  urinary  wastes  is  low,  then 
there  is  also  a  probable  adrenal  aspect. 

At  all  events,  the  use  of  adrenal  supportive  treatment,  as 
represented  by  Adreno-Spermin  Co.  (Harrower) ,  certainly 
can  do  no  harm  in  pellagra,  and  while  I  do  not  want  it  to  be 
presumed  that  I  am  recommending  this  as  a  treatment  of 
pellagra,  I  can  confidently  recommend  it  as  a  valuable  rem- 
edy in  conjunction  with  other  measures  and  for  the  purpose 
of  modifying  the  endocrine  aspects  mentioned. 


21.    SYPHILIS  AND  DEFECTIVE  CHILDREN 

Question:  "Answering  your  recent  letter  about  the  child 
I  wrote  you  about,  I  wish  to  say  that  both  Wassermann  and 
Noguchi  tests  were  positive,  which  speaks  for  syphilis.  Let 
me  know  if  you  think  that  this  syphilis  might  be  the  cause 
of  the  hypothyroidism  and  developmental  difficulty.  Should 
he  receive  the  salvarsan  treatment  before  giving  the 
Antero-Pituitary  Co.  (Harrower),  which  was  sent  me? 
His  mother  shows  a  negative  Wassermann.  Should  I  have  a 
Wassermann  made  of  his  father  also?  Does  salvarsan  cure 
cases  of  congenital  syphilis?' 

Answer:  My  personal  experience  indicates  that  syphilis 
is  a  common  cause  of  developmental  dystrophies  in  children. 
It  is  also  one  of  the  common  causes  of  serious  endocrine  dis- 


DEFECTIVE  CHILDREN  371 

orders  of  the  pituitary  and  other  glands.  Just  as  we  expect 
lues  to  influence  any  part  of  the  body  and  consider  it  as  a 
serious  toxemia,  so  we  expect  syphilis  to  be  a  common 
cause  of  dyscrinism,  and  we  also  expect  the  toxemia  of 
syphilis  to  have  a  similar  influence  upon  the  endocrine 
glands  to  the  toxemia  of  any  other  poisoning  or  infection. 
.  The  accepted  anti-syphilitic  treatment  is  not  directed  at 
the  endocrine  aspects  of  a  case  of  syphilis  with  endocrine 
dysfunction,  but  merely  at  the  cause  of  the  difficulty.  Cer- 
tainly, in  some  cases,  salvarsan  and  similar  products  bring 
about  what  are  called  "cures"  of  congenital  syphilis,  and 
accomplish  wonders  in  some  of  these  serious  ductless  glan- 
dular disturbances,  the  basis  of  which  is  a  congenital  or 
chronic  syphilitic  condition.  This  does  not  take  the  place  of 
the  organotherapy,  because  the  removal  of  the  cause  of  this- 
dyscrinism  merely  allows  the  ductless  glands  to  recuperate 
as  best  they  may,  whereas  organotherapy  by  the  principle  of 
homo-stimulation  encourages  these  glands  to  a  better  physi- 
ology and  development,  and  replaces  in  part  some  of  the  sub- 
stances missing  as  a  result  of  the  toxic  influence  upon  the 
endocrine  activity. 

In  the  case  of  developmentally  defective  children  found 
to  be  syphilitic  the  organotherapy  may  accompany  the  anti- 
syphilitic  treatment,  and  vice  versa,  and  I  have  repeatedly 
been  brought  in  touch  with  patients  who  are  develop- 
mentally  deficient,  and  who  have  taken  months  of  a  pre- 
sumably suitable  organotherapy  without  the  complete 
results  that  were  hoped  for  and  who  did  not  respond  to  the 
treatment  as  they  should  have  done  until  the  syphilitic  as- 
pect was  uncovered  and  treated  as  well.  In  other  words, 
organotherapy  has  failed  to  accomplish  all  that  wa& 
expected  of  it,  because  of  a  latent  syphilis  which  naturally 
could  not  be  influenced  by  the  organotherapy  alone.  On  the 
other  hand,  many  a  dystrophy  of  syphilitic  origin  is  ex- 
pected to  right  itself  automatically  when  a  series  of  anti- 
syphilitic  treatments  is  given;  and  this  is  hardly  fair,  be- 
cause it  is  expecting  too  much  of  the  recuperative  powers 
of  the  body.  Hence,  the  proper  thing  to  do  in  these  cases  is 
to  determine  as  much  as  possible  in  regard  to  both  the  cause 
and  effects  of  the  underlying  difficulty  in  these  cases,  and 
to  treat  the  cause  (the  syphilis)  and  antagonize  the  effects 
as  best  we  can  (by  organotherapy) . 

The  child  in  question  will  be  much  better  off  with  both 
anti-syphilitic  and  endocrine  treatment.  They  supplement 
one  another,  as  indicated,  and  experience  with  many  cases 


372  PRACTICAL   ORGANOTHERAPY 

confirms  the  impression  that  there  are  certainly  two  sides  to 
these  questions;  moreover  many  a  failure  has  been  due  to 
ignoring  one  of  them. 

In  regard  to  the  invariable  value  or  infallibility  of  the 
Wassermann  test,  I  cannot  say.  Presumably  it  is  a  useful 
indicator  as  in  the  case  of  this  child,  and  certainly  a  Wasser- 
mann should  be  made  in  the  case  of  the  father,  especially  as 
the  mother  is  said  to  be  negative. 

In  closing  these  remarks  I  cannot  but  emphasize  the 
necessity  for  considering  the  whole  aspect  of  these  cases,  not 
merely  the  obvious  troubles  before  us  but  the  underlying 
causes,  and  then  when  we  have  acquired  all  the  information 
possible,  treating  all  of  the  various  phases  of  the  case  simul- 
taneously, and  in  this  particular  instance,  give  the  child  the 
benefit  of  anti-syphilitic  treatment  as  well  as  a  treatment 
calculated  to  encourage  the  inefficient  endocrines. 


22.    SYMPATHETICOTONUS  IN  HYPERTHYROIDISM 

Question:  "I  have  a  young  lady  who  was  operated  ten 
months  ago  for  toxic  exophthalmic  goiter.  The  right  lobe  of 
the  thyroid  was  removed.  Considering  her  condition  at  the 
time  of  operation  she  made  a  good  recovery.  (Her  symp- 
toms were:  marked  exophthalmos,  tremor  so  bad  that  she 
could  not  walk  without  aid,  severe  asthenia,  and  a  pulse 
ranging  from  160  to  190.)  Since  the  operation  her  symp- 
toms have  cleared  up  considerably.  There  is  a  slight  en- 
largement of  the  remaining  lobe  of  the  thyroid  and  the  pulse 
is  still  120.  The  tremor,  however,  is  gone  and  there  has 
been  an  increase  in  strength  and  weight.  What  do  you 
suggest  in  pluriglandular  therapy?" 

Answer:  Without  a  doubt  the  operation  was  necessary 
and  the  patient  had  a  toxic  goitre.  However,  these  opera- 
tions do  not  always  remove  the  difficulties  entirely,  and,  un- 
fortunately, too  many  patients  are  left  with  very  seriously 
unbalanced  sympathetic  systems.  I  really  think  that  this 
patient  has  sympathetic  irritability  to  a  marked  degree,  evi- 
denced by  the  fact  that  the  pulse  is  still  120.  (Parentheti- 
cally, let  me  call  your  attention  to  the  first  issue  of 
Harrower's  Monographs  on  the  Internal  Secretions, 
which  gives  you  120  pages  of  practical  information  on 
Hyperthyroidism) . 

Now  the  organotherapy  that  I  have  recommended  for 
conditions  of  this  kind  is  not  so  much  directed  at  the  actual 
thyroid  enlargement  as  it  is  given  for  its  influence  upon  the 


ASTHENIC,  THIN,  WIRY  TYPE  373 

endocrine  system  as  a  whole  and,  in  turn,  upon  the  sympa- 
thetic system.  Personally  I  feel  that  in  a  good  many  of  the 
cases  where  the  thyroid  is  removed,  the  operation  should 
have  been  directed  at  the  tonsils,  the  sinuses,  the  appendix, 
or  at  least  some  focus  of  infection  which  was  causing  the 
serious  thyroid  irritability. 

At  all  events,  in  addition  to  your  further  search  for  in- 
formation of  this  type,  I  suggest  that  you  follow  the  outline 
made  in  my  little  reprint,  "My  Routine  in  Hyperthyroid- 
ism."  That  is  to  say,  in  addition  to  removing  the  various 
emotional  and  fatigue  factors,  and  emphasizing  the  value 
of  rest,  give  her  the  sympathetic  sedative  formula,  Pancreas 
Co.  (Harrower) ,  one,  four  times  a  day  and  perhaps,  a  little 
later,  even  two,  three  times  a  day,  and  combine  with  this  the 
remineralizing,  neutralizing  formula,  Calcium  Phosphorus 
Co.  (Harrower) ,  of  which  she  can  properly  take  three  one- 
gram  tablets,  crushed,  with  a  generous  drink  of  water,  an 
hour  before  food,  twice  a  day  for  three  weeks,  and  there- 
after on  alternate  weeks  during  the  treatment. 

Do  not  forget  that  organotherapy  in  hyperthyroidism  is 
directed  at  the  results  of  the  hyperthyroidism  rather  than 
at  the  thyroid  itself  and  the  cause  of  its  unusual  activity. 


23.    THE  ASTHENIC,  THIN,  BUT  WIRY  TYPE 

Question:  "You  remember  that  a  few  weeks  ago  I 
asked  you  to  discuss  more  fully  the  pharmacology  and  ther- 
apeutics of  Adreno-Spermin  Co.  I  wish  you  would  take  up 
especially  the  rationality  of  giving  thyroid  in  cases  of  my 
type.  Most  of  my  doctor  friends  believe  that  thin,  wiry 
individuals  like  myself  do  not  put  on  weight  because  of  a 
condition  of  hyperthyroidism  and  that  they  cannot  see  why 
Adreno-Spermin  Co.  is  indicated  in  such  individuals. 

"What  do  you  suggest  for  underweight  cases  who,  despite 
plenty  of  food,  do  not  put  on  weight  because  of  excessive 
mental  activity  or  overwork?  With  several  months'  rest 
very  likely  they  would  increase  their  body  weight  by  15 
pounds  or  so,  but  they  cannot  afford  it.  This  applies  to 
quite  a  number  of  men  that  I  know  personally." 

Answer:  First  of  all,  it  is  admitted  that  Adreno-Sper- 
min Co.  (Harrower)  is  a  means  of  stimulating  endocrine 
activity,  cellular  activity  and  the  chemistry  of  the  body  in 
general.  The  large  majority  of  individuals  who  are  asthenic 
and  run-down  are  suffering  from  an  accumulation  of  their 
own  wastes,  and  the  adrenal  depletion  merely  aggravates 


374  PRACTICAL   ORGANOTHERAPY 

this  condition.  Individuals  with  low  blood-pressure,  poor 
elimination  of  urea  and  subnormal  temperature  ordinarily 
have  a  pluriglandular  insufficiency.  The  adrenals  may  be 
affected  more  definitely  than  the  other  glands,  but  most  of 
these  cases  also  need  a  small  dose  of  thyroid.  Practically  all 
of  them,  of  course,  are  benefited  by  the  dynamogenic  influ- 
ence of  the  extracts  from  the  interstitial  cells  of  Leydig, 
and  in  many  hundreds  of  experiences — I  might  say  thou- 
sands— the  combination  has  been  superior  to  one  form  of 
monoglandular  therapy,  or  another. 

Now,  I  think  that  undoubtedly  there  are  individuals 
whose  chemistry  is  deranged  in  such  a  way  that  they  have 
malnutrition,  low  blood-pressure  and  general  asthenia,  and 
yet  their  sympathetic  systems  are  more  on  edge  and  their 
chemistry  is  more  rapid  than  those  just  outlined;  as  a 
result  of  which  they  do  not  retain  so  many  of  the  intra- 
cellular  elements  which  make  up  the  bodily  wastes.  Con- 
sequently, the  degree  of  toxemia  and  asthenia  is  not  so 
severe  in  this  type,  as  you  know. 

You  ask  what  change  in  the  organotherapy  I  would 
recommend  for  a  case  like  your  own  and  those  of  your  type. 
I  do  not  know.  Perhaps  organotherapy  is  not  the  thing  at 
all,  and  yet  on  the  other  hand  I  feel  confident  that  your  own 
experiences  as  well  as  those  that  you  have  seen  in  other 
cases  indicate  that  the  Adreno-Spermin  Co.  is  the  most  effi- 
cient remedy  for  the  ordinary  run-down  asthenic  type  of 
cases. 

Now,  we  have  two  other  preparations  on  our  list  that  are 
of  this  type  but  that  act  in  a  slightly  different  way.  Hepato- 
Splenic  Co.  (No.  5)  is  a  nutritional  stimulant  which  acts 
through  the  spleen  and  the  liver.  A  great  many  cases  of 
malnutrition  are  in  this  condition  because  the  liver  is  not 
functioning  normally,  and  usually  a  part  of  their  difficulties 
is  of  such  a  character  as  to  direct  attention  to  hepatic 
insufficiency. 

24.     SEVERE  ASTHENIA  FOLLOWING  NASAL  AND 
SINUS  INFECTION 

Query:  "Five  years  ago  Mr.  X  had  a  turbinectomy  and 
later  a  large  amount  of  necrosed  bone  was  removed.  After 
several  months  a  pronounced  anemia  developed,  accompanied 
by  lassitude  which  has  persisted  for  a  long  time,  causing  an 
aggravated  neurasthenia.  Might  this  condition  result  from 
destruction  ol  the  pineal  gland  at  the  operation,  or  after  it? 


SINUS  INFECTION  375 

"Again,  a  young  lady  operated  three  years  ago  for 
infected  ethmoids  and  turbinates  later  developed  pro- 
nounced neurasthenia  and  an  acute  melancholia.  There  is 
still  a  persistent  lassitude.  It  is  believed  that  these  two 
cases  are  similar  and  that  the  pineal  may  have  been 
destroyed.  Would  the  administration  of  the  pineal  gland 
either  alone  or  in  combination  with  adrenal  and  thyroid  sub- 
stance be  of  benefit  ? 

Answer:  I  have  never  heard  of  a  nasal  or  sinus  con- 
dition involving  the  pineal  gland.  It  might  more  likely  be 
a  possible  source  of  infection  reaching  the  pituitary  gland. 
I  do  not  think  that  the  pineal  gland  is  half  as  important  a 
gland  of  internal  secretion  as  some  have  indicated,  and  I 
have  had  very  little  to  say  about  the  value  of  pineal  therapy 
because  I  do  not  think  that  there  is  much  to  it !  Incidentally, 
it  takes  approximately  5,000  pineal  glands  to  make  a  pound 
of  the  useful  extract,  and  it  is  the  most  expensive  of  all  the 
glandular  products  obtainable,  and  not  half  as  valuable  as 
we  had  hoped  it  might  be.  Further,  it  will  be  recalled  that 
its  chief  prospective  source  of  value  was  in  certain  develop- 
mental disturbances  in  children.  The  experiences  of  those 
connected  with  the  institution  at  Vineland,  N.  J.,  which  were 
very  carefully  worked  out  and  published  some  years  ago, 
seem  to  have  convinced  the  medical  profession  that  the 
pineal  gland  is  not  nearly  so  intimately  connected  with 
developmental  disturbances  in  children  as  is  the  pituitary 
gland. 

In  these  cases  there  may  have  been  some  condition  of 
pituitary  dysfunction,  and  this  would  be  manifested  by  not 
merely  the  asthenia  and  other  conditions  mentioned  above, 
but  by  a  tendency  to  adiposity,  a  condition  of  lessened  sexual 
activity,  not  merely  functional,  but  organic,  and  an  increase 
in  the  tolerance  to  sugar :  in  other  words,  the  triad  of  symp- 
toms that  one  expects  to  find  in  hypopituitarism.  There 
might  also  be  a  condition  of  pituitary  enlargement  with 
pressure  symptoms,  including  severe  headaches.  The  diag- 
nostics of  pituitary  dysfunction  are  fully  discussed  in 
another  section. 

In  my  estimation,  the  adrenal  glands  are  the  most  likely 
to  have  been  involved  in  cases  of  this  kind.  In  fact,  the 
infective  conditions  so  commonly  encountered  by  the  nose 
and  throat  surgeon  must  all  of  them  have  a  more  or  less 
important  adrenal  aspect ;  and  I  would  like  to  say  here  that 
there  are  many  nose  and  throat  specialists  who  have  Come 
to  the  conclusion  that  in  addition  to  removing  as  best  they 


376  PRACTICAL   ORGANOTHERAPY 

can  the  foci  of  infection  in  the  tonsils,  sinuses,  etc.,  the 
simultaneous  support  of  the  adrenal  glands  is  worth  while 
treatment,  for  it  is  a  means  of  antagonizing  the  lassitude, 
asthenia,  and  consequent  neurasthenia  which  so  often 
accompany  conditions  of  this  kind. 

Hypoadrenia  very  commonly  accompanies  infective  con- 
ditions, and  it  makes  no  difference  whether  the  infection  is 
in  the  head,  gall  bladder,  appendix,  pelvis,  or  elsewhere.  In 
these  cases  very  often  there  is  an  associated  thyroid  insuffi- 
ciency on  the  very  general  principle  that  the  thyroid  is 
concerned  in  the  immunizing  response  and  that  an  excessive 
demand  upon  its  function  is  liable  to  play  it  out. 

The  treatment  for  this  aspect  of  these  cases,  in  my  esti- 
mation, would  be  adrenal  support  such  as  is  represented  by 
the  well-known  Adreno-Spermin  Co. 

25.     DEFICIENT  MAMMARY  DEVELOPMENT 

Query:  "I  have  a  friend  who  has  a  beautiful  daughter 
of  about  15,  who  seems  normal  in  every  way,  except  that  her 
breasts  are  not  developing.  Her  mother's  breasts  never 
seemed  to  develop,  though  she  nursed  her  baby  normally. 
Do  you  know  of  anything  which  would  promise  benefit?" 

Answer:  Mammary  therapy  has  been  recommended  by 
a  number  of  French  writers  for  the  development  of  mam- 
mary form  and  function,  though  my  own  experience  has 
been  practically  limited  to  the  application  of  this  idea  as  a 
galactagogue  and  not  as  a  bust  developer.  It  is  remarkable 
how  some  very  small-breasted  women  can  nurse  their  chil- 
dren, and  also  how  splendidly  apparently  atrophic  or  hypo- 
plastic  mammary  glands  can  be  encouraged  to  function  by 
means  of  organotherapy. 

We  have  a  formula  on  our  list,  called  Mamma-Ovary  Co. 
(Harrower),  which  is  used  for  the  treatment  of  excessive 
menstruation  in  girls,  and  which  might  possibly  be  bene- 
ficial in  the  hypoplastic  condition  referred  to.  We  have  an- 
other formula  called  Placento-Mammary  Co.  (Harrower), 
which  is  used  chiefly  as  a  galactagogue,  and,  by  the  way,  it 
is  one  of  the  most  remarkably  efficient  of  all  the  formulas 
on  our  list.  Either  of  these  two  forms  of  pluriglandular 
therapy  might  be  worthy  of  a  trial,  or  a  combination  of 
thyroid  and  mammary  without  ovarian  substance  might  be 
worth  considering. 

Of  course,  there  is  more  to  a  condition  of  this  kind  than 
an  endocrine  or  glandular  aspect,  and  the  use  of  mechanical 


CHRONIC  BRONCHITIS  377 

measures,  especially  cupping,  is  worthy  of  consideration, 
although  I  do  not  think  that  it  should  be  recommended 
unless  there  is  some  very  special  need  for  the  development. 

I  know  of  two  cases  that  have  followed  the  combined  line 
that  I  have  mentioned,  i.  e.,  the  use  of  Mamma^Ovary  Co. 
and  treatment  by  the  electrical  cupping  apparatus,  and 
also  the  generous  application  of  cold  mitten  friction  to  the 
breasts  (very  carefully)  with  quite  considerable  develop- 
ment. 


26.    CHRONIC  BRONCHITIS 

Query:  "Have  you  had  any  success  with  glandular  prod- 
ucts in  the  treatment  of  chronic  bronchitic  conditions?" 

Answer:  Bronchitis,  like  any  infection,  has  its  general 
influence  upon  the  body  and,  vice  versa,  the  general  condi- 
tion of  the  body  has  everything  to  do  with  the  establishment 
or  control  of  a  bronchitis.  In  other  words,  bronchitis  is  not 
merely  a  disturbance  of  bacterial  origin  involving  the  bron- 
chial mucosa.  The  same  thing  is  true  of  tuberculosis  and 
also  of  asthma,  both  of  which  are  closely  allied  to  bronchitis 
as  all  know  and  are  virtually  always  associated  one  with  the 
other.  In  other  words,  tuberculosis  is  pretty  nearly  always 
a  chronic  bronchitis  and  too  often  its  real  seriousness  is 
obscured  by  the  use  of  this  title ;  and  asthma  is  very  often 
nothing  in  the  world  but  a  chronic  bronchitis  with  an  un- 
usual sensitiveness  of  the  body  to  the  protein  products  of 
the  bronchial  secretion  and  its  contained  myriads  of 
bacteria. 

To  say  that  organotherapy  constitutes  the  treatment  for 
chronic  bronchitis  would  not  be  fair.  On  the  other  hand,  to 
say  that  organotherapy  will  cure  chronic  bronchitis  would 
give  offense  to  some.  But  the  fact  remains  that  when  an 
individual  has  dyscrinism — usually  the  hypoadrenia  syn- 
drome which  I  have  discussed  so  many  times  recently — 
the  regulation  of  this  dyscrinism,  the  increased  circulatory 
efficiency,  the  bettered  cellular  chemistry  and  the  general 
advantage  to  the  patient  have  given  them  an  especially  added 
responsiveness  to  be  able  to  overcome  the  bronchitis. 

In  this  class  of  cases  the  usual  treatment  is  directed  at  the 
chest,  with  ammonium  chloride  or  other  expectorants  to 
change  the  character  of  the  bronchial  secretion,  hydro- 
therapy  to  increase  the  local  circulation,  and  tonics  for  their 
general  value.  The  expectorants  agree  very  nicely  with  the 
tonics  and  organotherapy,  and  so  does  hydrotherapy,  hy- 


378  PRACTICAL  ORGANOTHERAPY 

giene,  dietetics,  etc. ;  but  to  my  way  of  thinking,  Adreno- 
Spermin  Co.  (Harrower)  takes  the  place  of  and  gives  a 
much  more  satisfactory  service  than  the  usual  tonic  mix- 
tures that  we  have  been  in  the  habit  of  using  in  these  cases. 
The  principle  of  adrenal  support  has  nothing  to  do  with 
bronchitis  as  such  save  only  as  the  endocrine  glands  have 
to  do  with  the  regulation  of  the  body's  defenses,  an  influ- 
ence which  has  been  quite  thoroughly  established  these 
many  years.  To  answer  the  question  again  and  briefly: 
Organotherapy  is  a  valuable  adjuvant  in  the  treatment  of 
chronic  bronchitis,  caring  as  it  does  for  conditions  so  com- 
monly associated  with  bronchitis  and  so  ordinarily  left 
untreated. 


THE  VOMITING  OF  PREGNANCY 

Query:  "You  may  be  interested  to  learn  of  an  experi- 
ence I  had  with  a  case  of  serious  vomiting  of  pregnancy 
with  your  Placenta  Co.  Mrs.  B,  3-para,  previously  had 
had  'terrible  times'  with  nausea  and  vomiting  in  her  two 
previous  pregnancies;  came  under  my  care  six  or  seven 
weeks  pregnant  with  'the  same  old  trouble'  and  'as  bad  or 
worse  than  ever.'  I  treated  her  with  chloretone,  triple  bro- 
mides, and  later  morphin.  Practically  no  results  in  a  month. 
A  friend  of  the  lady  told  of  having  been  given  some  'glandu- 
lar medicine'  by  a  doctor  in  Salt  Lake,  which  stopped  her 
similar  trouble  very  soon.  I  got  this  doctor's  name  and 
wrote  him,  was  put  in  touch  with  your  Denver  office,  and 
finally  got  the  remedy  for  my  patient.  In  ten  days  every- 
thing was  lovely.  Patient  beginning  to  get  up,  holding 
everything  down,  and  practically  no  more  nausea,  the  vomit- 
ing having  ended  several  days  before. 

"I  would  like  to  know  why  this  measure  is  not  better 
known  ?  I  have  tried  it  already  on  three  other  cases  and  it 
was  'a  sure  shot.'  Have  you  any  more  literature  on  this 
subject?" 

Answer:  One  reason  why  this  preparation  is  not  better 
known  is  that  it  consists  largely  of  a  product  which  is  not 
accepted  by  "authority."  You  know  that  there  are  certain 
self-constituted  arbiters  of  the  destinies  of  therapeutics  who 
sometimes  are  not  as  well  posted  on  some  things  as  some 
other  people,  and  it  happens  that  these  individuals  have 
ruled  that  this  and  several  other  organotherapeutic  prod- 
ucts are  not  proper  for  good  physicians  to  use.  (See  Section 
I,  under  the  heading,  "The  Character  of  These  Products.") 


VOMITING  IN  PREGNANCY  379 

Another  reason  why  the  preparation  is  not  better  known 
is  that  there  are  limitations  to  my  work.  You  may  not  know 
it,  but  a  few  physicians  feel  that  the  work  of  The  Harrower 
Laboratory  is  altogether  too  commercial.  Just  yesterday  I 
received  a  letter  from  a  physician  in  Texas,  calling  me  down 
and  closing  his  letter  in  the  following  terms :  "I  believe  the 
majority  of  people — at  least  a  large  percentage  of  all  pro- 
fessions— are  gullible,  and  I  resent  any  suggestion  that  I 
exploit  or  be  exploited.  I  cannot  see  any  motive  except  a 
desire  for  material  gain  in  such  extensive  advertising  as 
you  now  carry  out."  He  forgot  that  our  dealings  are  solely 
with  the  medical  profession,  and  that  success  only  comes  to 
those  who  "keep  everlastingly  at  it." 

There  are  many  good  things  known  to  certain  physicians 
and  commonly  used  by  them  which  are  not  always  appreci- 
ated by  their  colleagues.  I  am  glad  to  say  that  there  have 
been  many  instances  of  the  type  outlined  in  your  letter.  I 
recall  one,  but  this  time  the  preparation  was  Placento-Mam- 
mary  Co.  (Harroiver),  a  galactagogue  formula.  At  a 
meeting  of  the  California  State  Medical  Association  a  promi- 
nent physician  came  up  to  me,  pulled  a  capsule  out  of  his 
pocket  and  said:  "Could  you  tell  me  what  this  is?"  I  told 
him  that  it  was  not  always  easy  to  determine  the  character 
of  a  glandular  preparation  by  mere  observation  and  asked 
him  what  it  was  supposed  to  be  for.  He  said  that  one  of  his 
patients  having  had  difficulty  in  nursing  her  children  had 
learned  from  one  of  her  friends  that  in  similar  circum- 
stances she  had  been  given  a  certain  preparation  which 
helped  very  materially  to  increase  the  amount  of  her  milk, 
and  kindly  divided  her  supply  with  the  other  patient.  It 
began  to  render  service  almost  immediately  and  when,  this 
woman  who  had  been  visiting  came  back  to  Los  Angeles  and 
visited  her  physician,  she  told  him  of  the  experience  and  he 
got  one  of  the  capsules,  which  was  the  one  shown  to  me. 
This  man  had  every  chance  in  the  world  to  know  of  my 
work.  And  yet  it  was  through  a  coincidence  similar  to  your 
own  that  he  was  brought  in  touch  with  the  galactagogue 
value  of  this  particular  product.  Like  Placenta  Co.  (Har- 
rower) the  galactagogue  preparation  is  "not  accepted"- 
it  is  in  advance  of  the  field. 

I  was  very  much  interested  in  the  fact  that  already  you 
had  duplicated  your  experiences  several  times  and  that  you 
believe  that  this  particular  method  of  treating  the  vomiting 
of  pregnancy  is  "a  sure  shot."  It  is  not,  because  it  is  very 
clear  from  the  clinical  experiences  which  have  been  related 


380  PRACTICAL   ORGANOTHERAPY 

to  me  and  some  of  my  own  as  well,  that  this  form  of  organo- 
therapy only  reaches  a  certain  type  of  cases  of  vomiting  of 
pregnancy.  As  I  have  tried  to  explain  elsewhere,  evidently 
this  particular  class  of  cases  includes  the  women  who,  hav- 
ing a  tendency  to  protein  sensitization,  are  particularly  dis- 
turbed by  the  protein  evidently  produced  in  the  placenta  and 
carried  into  the  circulation.  In  other  words,  they  have  an 
anaphylaxis  against  these  products,  and  if  you  will  investi- 
gate a  number  of  cases  of  vomiting  of  pregnancy,  you  will 
find  that  many  of  them  will  report  to  you  that  they  cannot 
eat  certain  foods — strawberries,  shell  fish,  eggs,  etc. — be- 
cause they  usually  disagree  with  them,  and  cause  a  rash, 
nausea  or  other  unpleasant  reactions. 

The  administration  of  the  Placenta  Co.  seems  to  increase 
the  immunity  of  the  body  somewhat  in  the  manner  that  we 
can  increase  an  immunity  to  hydrophobia  after  the  bite  and 
before  the  organism  has  time  to  develop  its  full  and  fatal 
influence.  Whether  this  explanation  of  its  value  is  correct 
or  not  it  does  indeed  have  value.  For  instance,  a  doctor 
writes :  "I  have  now  brought  another  woman  to  the  middle 
of  pregnancy  with  practically  no  nausea  except  for  a  few 
times  when  she  was  not  taking  No.  49 — Placenta  Co.  (Har- 
rower) for  a  short  time.  She  had  dreaded  this  pregnancy 
very  much  because  of  her  extreme  nausea  with  her  last 
baby,  and  she  and  her  husband  both  wished  a  termination 
of  the  pregnancy  because  of  her  past  experience.  She  is  now 
going  about  at  five  months  with  no  symptoms  and  has  prac- 
tically stopped  treatment." 

If  you  have  a  patient  with  nausea  or  vomiting  of  preg- 
nancy, no  matter  how  early  during  the  pregnancy  or  how 
serious  it  may  be,  certain  it  is  that  the  use  of  Placenta  Co. 
(Harrower)  is  a  reasonable  measure,  because  it  has  helped 
before,  as  you  know  very  well.  Perhaps  this  is  one  of  the 
empirical  procedures  that  I  am  criticized  for,  but  if  you 
succeed  in  helping  your  patient,  what  do  you  care  for  all  the 
criticisms  of  those  who  have  nothing  whatever  to  do  with 
your  personal  affairs?  The  patient  takes  care  of  you  and 
shouts  your  praises  from  one  end  of  the  town  to  the  other, 
and  in  addition  to  the  professional  advantages  that  this 
may  have,  you  certainly  have  a  good  deal  of  personal  satis- 
faction in  having  accomplished  something  that  otherwise 
you  might  have  failed  to  dp.  As  Elbert  Hubbard  once  said, 
"There  is  a  sweet  satisfaction  in  having  passed  along  a  good 
thing" — and  Placenta  Co.  (Harrower)  is  a  good  thing  in 
the  vomiting  of  pregnancy  in  many  instances. 


DEFICIENT  NUTRITION  381 

28.     DEFICIENT  NUTRITION  IN  A  CHILD 

Query:  "I  have  a  three  year  old  child  weighing  only  18 
pounds,  who  is  very  much  below  par  in  every  way.  Men- 
tally, however,  the  child  is  as  bright  as  one  could  expect 
and  it  occurred  to  me  that  instead  of  the  Antero-Pituitary 
Co.  which  I  have  used  successfully  in  defective  children, 
some  other  preparation  would  be  more  suitable.  Can  you 
give  me  some  help?" 

Answer:  Ordinarily  Antero-Pituitary  Co.  (Narrower) 
is  given  to  children  who  do  not  develop  properly  in  so  far  as 
both  their  growth  and  mentality  are  concerned.  The  child 
you  write  of  apparently  has  not  grown  in  stature,  although 
mentally  it  is  normal  and  may  be  diminutive  or  perhaps  the 
case  is  merely  one  of  insufficient  nutrition.  If  the  child's 
height  in  relation  to  its  age  is  not  far  from  the  average 
and  the  appearance  indicates  malnutrition,  another  line 
of  treatment  suggests  itself. 

The  first  thing  to  find  out  is  whether  there  is  some  re- 
movable cause  of  the  difficulty,  as,  for  example,  worms. 
It  is  also  necessary  to  find  out  if  the  child's  nutrition  is 
low  because  of  a  digestive  incapacity,  i.  e.,  a  lack  of  assimi- 
lative power  on  the  part  of  the  bowel.  This  is  sometimes 
found  out  by  dietetic  experiment  and  fecal  analysis  which 
should  be  carried  out  for  sometime  in  conjunction  with 
every  effort  to  reduce  alimentary  toxemia  and  lessen  the 
burden  upon  the  organs  that  are  affected  by  such  toxemia. 

The  use  of  the  bacillus  Bulgaricus,  as  in  the  culture  known 
out  here  in  California  as  "Vitalait",  is  sometimes  very  ef- 
ficient in  the  treatment  of  such  children  and,  in  addition  to 
this  the  newer  vitamine  therapy  that  is  now  coming  into 
vogue  certainly  helps  to  facilitate  the  nutritive  powers  in 
this  class  of  cases. 

One  of  the  best  morphpgenic  nutrition-stimulating  reme- 
dies is  phosphorus,  and  it  happens  that  three  of  the  best 
and  most  acceptable  forms  of  phosphorus  are  of  animal 
origin — lecithin  is  the  chief  of  these  and  the  other  two, 
nucleinic  acid  and  the  glycerophosphates,  while  originally 
secured  from  animal  glands,  now  are  made  more  cheaply 
from  other  sources. 

According  to  Potter,  phosphorus  in  small  doses  stimulates 
metabolism  and  especially  the  growth  of  bones.  '  The  effect 
on  metabolism  is  to  increase  the  nitrogenous  product  and  to 
dimmish  the  excretion  of  carbon  dioxide.  Phosphorus  is 
used  chiefly  to  promote  nutrition.  It  is  also  useful  in  nerv- 


382  PRACTICAL  ORGANOTHERAPY 

ous  exhaustion  due  to  overwork  as  well  as  in  rickets  and 
osteomalacia.  Potter  suggests  certain  phosphorus  prepara- 
tions as  a  gastric  tonic  to  be  given  to  weak,  anemic  children 
with  the  view  of  improving  the  appetite  and  nutrition. 

We  have  a  preparation  of  phosphorus,  known  as  Nucleo- 
Lecithin  Co.  (Harrower),  No.  14  on  our  list,  the  adminis- 
tration of  which  sometimes  has  exerted  a  very  remarkable 
stimulating  effect  upon  nutrition,  particularly  in  the  young. 
This  contains  a  generous  dose  of  90-95%  lecithin,  supple- 
mented by  suitable  amounts  of  nucleinic  acid,  for  its  known 
cell-stimulating  and  especially  white-cell-stimulating  effect 
(nuclein  is  said  to  be  one  of  the  most  useful  leucocytogenic 
remedies)  and  calcium  glycerophosphate  as  a  useful  "chem- 
ical food." 

The  use  of  this  formula  in  children  of  the  type  mentioned 
sometimes  gives  just  the  fillip  necessary  to  the  nutritive 
exchanges,  and  the  use  of  15  to  30  grains  a  day,  in  divided 
doses,  is  to  be  recommended  in  conjunction  with  a  careful 
dietetic  handling  and  the  eliminative  regulation  already 
mentioned. 

Incidentally,  this  phosphorus  preparation  is  sometimes 
very  valuable  in  senile  neurasthenic  conditions,  which  are 
accompanied  by  malnutrition  and  cachexia. 


29.    ADRENAL  INDIGESTION 

Query:  "I  have  a  patient  who  evidently  has  hypoadrenia 
— the  blood  pressure  is  90-55,  temperature  about  96.2  each 
morning,  and  she  is  tired  and  weak.  For  years  her  chief 
difficulty  has  been  with  her  digestion.  Food  lies  in  her 
stomach  and  ferments.  Her  breath  is  very  foul.  She  has 
abominable  eructations  and  I  have  had  to  wash  out  her 
stomach  several  times.  It  occurs  to  me  that  besides  rest, 
dietetic  control  and  the  hydriatic  measures  we  use  here, 
some  of  your  treatment  might  help.  Would  you  give  the 
Adreno-Spermin  formula  or  Secretin  Co.,  and  why?" 

Answer:  We  do  not  know  whether  the  adrenal  insuf- 
ficiency to  which  you  refer  and  which  the  woman  undoubt- 
edly has,  is  a  cause  of  her  digestive  insufficiency,  or  the  re- 
sult of  it.  Either  might  be  the  case.  The  tiredness  and  weak- 
ness to  which  you  refer  undoubtedly  extends  to  the  ali- 
mentary musculature,  and  her  digestive  tract  must  be 
equally  tired.  She  might  have  had  some  original  difficulty, 
the  nature  of  which  would  deplete  the  adrenals,  which  is 
really  at  the  bottom  of  her  indigestion — a  focus  of  infec- 


ADRENAL  INDIGESTION  383 

tion,  a  serious  infectious  disease,  like  influenza  or  a  severe 
shock. 

I  am  reminded  of  a  translation  which  was  made  here  of 
an  article  by  Hernando,  a  Spanish  physician  whose  article 
appeared  in  Medicina  Ibera,  Madrid,  for  October  11,  1919. 
This  writer  calls  attention  to  the  influence  of  the  glands  of 
internal  secretion  upon  the  digestive  apparatus,  not  only  by 
the  hormones  themselves,  but  through  the  intermediary  of 
the  vegetative  nervous  system.  What  Hernando  calls  "uni- 
versal asthenia"  and  also  ptosis  of  abdominal  muscles  and 
contents,  are  also  probable  consequences  of  changes  of  this 
character.  There  is  no  doubt  also  that  the  secretion  of  the 
gastric  glands  may  be  modified  by  endocrine  function  and 
this  is  usually  in  the  line  of  hyposecretion.  Hernando  calls 
attention  to  the  fact  that  persons  with  adrenal  insufficiency 
have  a  defective  gastric  secretion.  His  own  research  and 
that  of  others,  especially  in  France,  has  demonstrated  that 
hypoadrenia  provides  conditions  favorable  for  the  develop- 
ment of  gastric  ulcer  and  the  modified  functioning  of  the 
vegetative  nervous  system  favors  a  tendency  towards  low 
resistance  to  infection. 

Emphasis  is  laid  upon  the  injurious  effects  of  fatigue  and 
the  emotions  on  persons  with  hyperchlorhydria  and  gastric 
ulcer  and  it  is  suggested  that  these  conditions  may  be  ex- 
plained by  the  exhaustion  of  the  adrenals  which  they  induce. 
Attention  is  also  called  by  this  same  writer  to  the  benefit 
realized  as  the  adrenals  are  permitted  to  recuperate  under 
a  rest  cure  or  when  adrenal  therapy  is  advised.  This  article 
is  supplemented  by  a  very  large  bibliography  and  to  my 
mind  is  strictly  in  harmony  with  the  facts. 

Taking  it  for  granted  that  the  hypoadrenia  which  you 
determine  is  present  should  be  treated,  the  natural  question 
arises  whether  Adreno-Spermin  Co.  (Harrow  er)  should  be 
used,  or  Secretin  Co.  (Harrow  er) ,  and  I  would  be  willing  to 
give  either  to  this  patient  with  the  expectation  of  some  bene- 
fit. The  former  has  a  more  general  effect.  That  is  to  say, 
it  acts  upon  the  glands  which  are  involved  in  the  complex. 
Secretin  Co.,  on  the  other  hand,  contains  a  sufficiently  gen- 
erous dosage  of  adrenal  substance  to  get  a  good  deal  of  the 
tonic  effect  from  it,  especially  upon  the  alimentary  muscles 
and  in  addition  has  a  large  enough  dose  of  bile  salts  to  en- 
courage the  liver  which  must  be  equally  inactive  with  the 
rest  of  the  digestive  system  and  finally,  most  important  of 
all,  the  duodenal  principle,  secretin,  which  I  really  believe 
has  a  therapeutic  value  especially  in  the  very  class  of  cases 


384  PRACTICAL  ORGANOTHERAPY 

of  which  this  woman  is  a  type. 

I  would  continue  to  wash  out  her  stomach  and  certainly 
she  will  be  advantaged  by  the  sanitarium  treatment  that 
she  is  able  to  get  there.  In  addition  to  this  I  would  give 
Secretin  Co.  (Narrower)  ten  grains,  three  or  even  four 
times  a  day,  preferably  between  meals. 

Another  important  aspect  to  these  cases  is  the  matter  of 
remineralization  to  which  your  attention  already  has  been 
called.  I  would  give  her  Calcium-Phosphorus  Co.  (Nar- 
rower) three  tablets,  crushed,  with  much  water,  and  as  far 
away  from  food  as  possible,  twice  a  day  for  at  least  a 
month  in  attempt  to  antagonize  the  tendency  to  acidosis 
unquestionably  present  in  so  asthenic  and  toxic  a  person. 


30.    PARKINSON'S  DISEASE 

Query:  "What  is  your  opinion  in  regard  to  the  parathy- 
roid treatment  of  paralysis  agitans?" 

Answer:  That  it  is  of  some  prospective  benefit  in  certain 
cases;  but  that  it  is  not  an  encouraging  method  of  treat- 
ment. Paralysis  agitans  still  is  an  incurable  disease.  It 
certainly  seems  to  involve  the  parathyroid  glands  as  Berke- 
ley of  New  York  and  others  have  found.  I  have  recom- 
mended Parathyroid  Co.  (Narrower) — a  combination  of 
active  parathyroid  extract,  spermin  from  the  interstitial 
cells  of  Leydig  for  its  general  tonic  effect,  and  bile  salts  for 
the  hepatobiliary  stimulating  effect,  with  reported  benefit 
in  several  hundred  cases  of  paralysis  agitans.  The  drooling 
has  been  ended  in  many  instances,  the  insomnia  is  often 
benefited  quite  early  in  the  treatment,  the  tremor  has  been 
lessened,  and  I  know  of  cases  where  the  patient,  previously 
unable  to  feed  himself  and  to  button  his  clothes,  after  two 
months  of  treatment  had  recovered  these  faculties. 

W.  N.  Berkeley  believes  that  "sixty  to  seventy  per  cent, 
of  those  who  give  this  a  fair  trial  for  three  months,  have 
been  greatly  benefited'*  and  since  the  prospects  in  Parkin- 
son's disease  are  so  poor,  they  should  at  least  have  the 
benefit  of  the  doubt  and  try  the  parathyroid  therapy  in  con- 
junction with  whatever  measures  seem  advisable,  as  for  ex- 
ample, hyoscin,  massage  and  hydrotherapy. 


31.     EARLY  POSTPARTUM  MENSES 

Query:  "I  have  a  woman  age  33  now  nursing  her  fourth 
baby,  who  reports  that  her  menstruation  is  usually  estab- 
lished from  three  to  five  weeks  after  delivery.  She  always 


EARLY  POSTPARTUM  MENSES  385 

has  had  difficulty  in  nursing  her  children  and  each  of  the 
first  three  began  to  use  the  bottle  within  a  month  or  six 
weeks  of  their  birth.  At  present,  the  fourth  baby  is  five 
weeks  old  and  nursing  already  is  quite  unsatisfactory.  The 
baby  has  a  digestive  difficulty  and  the  mother  fears  the 
bottle.  A  slight  menstruation  began  a  few  days  ago.  Uterus 
is  still  large,  boggy  and  quite  tender.  Have  you  any  or- 
ganotherapeutic  suggestion  ?" 

Answer :  My  suggestion  is  to  use  Placento-Mammary  Co. 
(Harrower) ,  ten  grains,  three  or  four  times  a  day  for  two 
weeks  and  perhaps  thereafter  in  one  half  the  above  dosage. 
This  form  of  organotherapy  is  not  merely  galactagogue  in 
its  influence,  as  has  been  proved  in  a  good  many  thousand 
cases,  but  it  exerts  a  decongestive  influence  on  the  pelvis.  It 
has  been  known  actually  to  prevent  early  postpartum  men- 
struation. I  recall  meeting  a  physician  in  the  lobby  of  the 
office  building  in  which  I  used  to  be  and  she  told  me  of  some 
experiences  that  she  was  having  with  a  nursing  mother. 
She  asked  me  the  question  if  I  did  not  believe  that  No.  3 
(the  formula  we  are  talking  about)  had  some  influence  on 
the  uterus  as  well  as  on  nursing,  and  I  naturally  told  her 
it  must  have,  because  nursing  has  an  influence  upon  the 
uterus.  Subinvolution  is  quite  common  in  women  who  do 
not  nurse  their  children,  and  it  is  believed  by  those  who  have 
studied  the  matter  that  one  of  the  reasons  for  ovarian  and 
uterine  troubles  in  women,  is  the  fact  that  they  so  often 
neglect  to  nurse  their  children  and  get  the  reflex  benefit 
that  the  use  of  this  function  has  upon  the  pelvic  organs. 

This  doctor  reported  that  the  treatment  had  not  merely 
encouraged  the  production  of  milk,  but  had  depleted  the  pel- 
vic organs,  lessened  the  size  of  the  uterus  and  stopped  the 
flow — for  there  was  no  menstruation  until  seven  months, 
whereas  previously  two  or  three  months  had  been  the  usual 
time  that  menstruation  began.  Maybe  it  was  a  coincidence, 
but  it  has  happened  a  good  many  times. 

[I  am  able  to  add  here  that  the  suggestion  made  to  this 
correspondent  caused  considerable  improvement  in  the 
amount  and  quality  of  milk.  The  baby  gained  very  nicely, 
continued  nursing  for  five  months  longer,  the  involution  of 
the  uterus  was  noticeably  hastened  and  instead  of  a  men- 
struation which  ordinarily  began  three  to  five  weeks  after 
delivery  and,  mind  you,  had  followed  this  plan  for  three 
previous  experiences,  now  the  menses  were  not  reestab- 
lished until  seven  months,  which  we  believe  is  clinical  proof 
that  this  phase  of  organotherapy  is  really  effective  and  that 

M 


386  PRACTICAL  ORGANOTHERAPY 

it  serves  (1)  as  a  galactagogue,  (2)  as  a  uterine  involutant, 
(3)  delays  abnormally  early  postpartum  menses  and  (4) 
increases  the  baby's  weight  and  health. — H.  R.  H.] 

By  the  way,  a  Pasadena  physician  was  in  the  office  yes- 
terday telling  some  wonderful  things  about  this  formula. 
A  case  in  point  was  a  woman,  two  months  overdue,  with  a 
12i/^-pound  baby,  48  hours  in  labor  with  a  tear  clear  through 
into  the  rectum.  Naturally  she  had  a  hard  time  after- 
wards, nursing  was  not  very  successful  and  "the  uterus  was 
clear  up  to  the  liver  several  days  after."  The  Placento- 
Mammary  Co.  was  given  with  immediate  and  progressive 
benefit  both  to  the  subinvoluted  uterus  and  to  the  nursing. 


32.    SYMPATHETICOTONUS  AND  TUBERCULOSIS 

Query:  "I  have  been  in  the  habit  of  using  your  Adreno- 
Spermin  Co.  as  a  tonic  in  patients  with  tuberculosis  and 
must  confess  that  it  has  seemed  to  be  of  great  advantage. 
I  now  have  a  case  of  tuberculosis  to  whom  I  fear  to  give 
thyroid  in  any  dosage  and  will  be  pleased  to  have  your 
suggestions  regarding  another  formula  for  the  same  pur- 
pose as  No.  1  but  without  any  possibility  of  irritating  an 
already  overirritated  thyroid." 

Answer:  All  conditions  of  glandular  depletion,  to  my  way 
of  thinking,  are  the  result  of  glandular  stimulation,  and 
your  patient  at  present  has  a  toxemia  which  is  irritating 
various  parts  of  the  organism,  including  the  thyroid. 

Doubtless  the  depletability,  if  I  may  use  the  word,  of 
various  glands  differs  in  degree  and  some  thyroids,  espe- 
cially, take  the  toxic  stimuli  very  seriously,  and  a  condition 
of  hyperthyroidism  complicates  the  original  trouble. 
Adreno-Spermin  Co.  (Narrower)  contains  one  twelfth  of  a 
grain  of  desiccated  thyroid  in  each  dose.  Enough,  perhaps, 
to  be  a  detriment  to  an  individual  with  a  well-defined  hyper- 
thyroidism, but  not  enough  to  cause  any  harm  if  used  for  a 
short  time.  We  have  another  formula,  however,  Pancreas 
Co.  (Harrower)  which,  as  you  know,  is  used  in  the  treat- 
ment of  the  heart  hurry,  sympathetic  irritability  and  other 
difficulties  of  hyperthyroidism.  Why  not  consider  that  your 
patient  has  sympatheticotonus,  as  undoubtedly  he  has,  and 
treat  it?  In  a  case  of  this  type  Pancreas  Co.  will  have  its 
usual  benefit  upon  digestion,  which  is  always  advisable  in 
tuberculosis,  it  may  exert  its  expected  sympathetic  sedative 
influence  and,  best  of  all,  it  has  been  used  by  at  least  three 
physicians,  with  whom  I  am  personally  acquainted,  in  tuber- 


POST-ENCEPHALITIS  SEQUELAE  387 

culosis  with  a  mild  hyperthyroidism  with  benefit  to  both 
conditions. 

I  am  glad  to  know  that  you  have  acquired  confidence  in 
the  use  of  Adreno-Spermin  Co.  (Harroiver)  in  the  asthenic, 
run-down,  tuberculous  individuals.  It  is  worth  while  treat- 
ment, and  so  is  the  Pancreas  Co.  in  the  particular  variation 
of  these  cases  that  you  refer  to. 


33.     POST-ENCEPHALITIS  SEQUELAE 

Query:  "Have  you  secured  any  results  in  the  treatment 
of  post-encephalitis  cases?  I  have  an  18-year-old  girl  who 
was  quite  well  up  to  November  1919  when  she  had  epidemic 
encephalitis.  Since  that  time  she  has  shown  a  steady  fail- 
ure. At  times  her  appearance  indicates  a  typical  dementia 
praecox  with  blank  features,  excessive  salivation,  but  men- 
tality not  especially  disturbed.  Then  again  she  presents  a 
Parkinsonian  aspect  with  tremor  and  a  rather  festinating 
gait.  Her  blood  pressure  is  low  (105-60).  Is  there  any 
possibility  of  a  serious  glandular  disturbance  with  some 
hope  from  organotherapy,  or  must  I  throw  her  into  the  dis- 
card, as  will  naturally  be  the  case  if  her  trouble  is  due  to 
definite  organic  lesion  in  the  stem  and  cord?" — Washing- 
ton. 

Answer:  It  seems  to  be  generally  believed  that  encepha- 
litis-lethargica,  or  as  the  British  have  come  to  call  it,  "sleepy 
sickness,"  is  in  some  way  related  to  the  same  fundamental 
causative  element  (an  organism,  it  is  presumed)  as  influ- 
enza. I  am  sure  that  this  may  be  true  and  that  the  epidemic 
of  sleepy  sickness  which  has  been  a  good  deal  worse  abroad 
than  in  this  country,  is  nothing  but  a  specialized  recurrence 
of  influenza. 

Without  a  doubt  there  are  serious  changes  in  the  cerebro- 
spinal  structures.  The  paralyses  and  the  conditions  that  you 
outline  so  lucidly  in  your  question,  are  not,  to  my  mind, 
functional,  but  rather  the  result  of  definite  changes  in  the 
actual  nerve  structures. 

It  does  seem  a  terrible  thing  to  have  to  "throw  her  into 
the  discard"  as  you  indicate,  and  it  has  happened  that  some 
of  these  cases  of  epidemic  influenzal  encephalitis  have  been 
benefited  in  some  ways  by  treating  the  endocrine  aspects 
which  naturally  follow  so  serious  a  toxemia.  The  masses 
among  the  profession  have  accepted  our  belief  that  influenza 
causes  hypoadrenia,  and  that  the  most  serious  manifesta- 
tions of  influenza  are  the  changes  in  the  adrenal  structure, 


388  PRACTICAL  ORGANOTHERAPY 

or  at  least,  adrenal  function,  which  leave  the  patient  so 
tremendously  played  out,  asthenic,  and  unable  to  accomplish 
anything  either  cellularly  or  by  use  of  the  will. 

Every  case  of  serious  toxemia,  no  matter  whether  bacte- 
rial or  chemical,  must  have  some  sort  of  an  adrenal  aspect. 
The  adrenal  glands  are  involved  in  all  of  these  cases,  and  I 
really  believe  that  there  is  a  very  serious  endocrine  deple- 
tion involving  not  merely  the  adrenals  but  all  of  the  en- 
docrine glands,  just  as  the  whole  body  is  seriously  changed 
in  its  metabolic  and  cellular  functions  as  a  result  either  of 
the  toxemia,  or  the  combination  of  circumstances  connected 
with  the  lethargic  aspects  of  the  case.  In  other  words, 
there  is  an  endocrine  lethargy  also. 

In  such  a  case,  especially  when  the  blood-pressure  is  low 
as  here,  I  would  advise  adrenal  support.  I  recommend  it 
routinely  in  all  cases  of  early  or  late  influenza,  in  the  sim- 
ple, easy  cases,  or  in  the  most  serious  and  almost  hopeless 
cases.  It  is  good  practice  to  encourage  the  adrenals  or  to 
prevent  their  depletion — routinely.  I  know  of  cases  who 
are  alive  today  as  the  result  of  adrenal  support.  I  know 
of  other  cases  whose  entire  aspects  were  changed  within  a 
week  or  two  by  adding  to  an  apparently  suitable  line  of 
treatment,  the  support  of  the  adrenal  glands  by  the  use  of 
the  Adreno-Spermin  Co.  (Harrower)  which  we  have 
shouted  about  these  many  years  and  which  has  been  used 
successfully  in  literally  thousands  of  cases  of  influenza. 

I  admit  that  it  has  not  been  used  as  frequently  in  epi- 
demic lethargic  encephalitis  and  I  could  not  say  in  advance 
what  the  results  might  be  in  the  girl  to  whom  you  refer, 
but  if  she  were  my  patient,  I  would  most  assuredly  give  her 
the  benefit  of  the  doubt  and  support  her  adrenals  generously 
for  a  period  of  three  or  four  months  if  only  as  a  diagnostic 
measure. 

Give  her  the  Adreno-Spermin  Co. — a  five-grain  dose  every 
three  hours  for  a  month  and  thereafter  one,  four  times  a 
day,  at  meals  and  bedtime.  In  a  case  like  this  the  prin- 
ciples of  remineralization  which  I  have  frequently  referred 
to  in  my  writings  obviously  apply.  Antagonize  the  tendency 
to  acidity  so  common  in  these  cases,  remineralize  and  les- 
sen the  burden  of  the  already  overworked  endocrines.  Give 
the  Calcium  Phosphorus  Co.  in  doses  of  three  grams, 
crushed,  an  hour  before  meals  twice  a  day  for  three  or  four 
weeks  and  thereafter  on  alternate  weeks. 

Add  these  measures  to  all  of  the  other  measures  that  may 
occur  to  you  from  the  standpoint  of  medicine,  electrother- 


MENOPAUSAL  HYPERTENSION  389 

apy,  dietetics,  or  general  hygiene.  Organotherapy  and  re- 
mineralization  are  invariably  adjuvant  measures.  I  do  not 
care  whether  the  results  are  credited  to  the  organotherapy 
or  to  other  things  which  may  be  done  simultaneously.  The 
point  is  to  do  everything  possible  for  these  unfortunate  in- 
dividuals, and  one  of  the  possibilities  is  along  the  lines  that 
I  have  spoken  of.  It  may  not  be  a  very  hopeful  procedure, 
but  to  my  way  of  thinking  at  least  it  is  well  worth  a  trial. 

34.    HYPERTENSION  AT  THE  MENOPAUSE 

Query:  "I  have  two  cases  in  women,  one  about  40  years 
old  and  the  other  45,  both  of  whom  are  in  the  change  of  life, 
whose  blood-pressure  ranges  from  190  to  240.  These  women 
seem  to  have  a  similar  condition  and  it  occurred  to  me  that 
you  might  be  able  to  give  some  assistance." 

Answer:  Functional  hypertension  is  a  common  symptom 
of  the  menopause.  Chief  among  these  disturbances  of  this 
period  are  irregularities  in  the  circulation  and  sympathetic 
nervous  system.  The  removal  of  the  ovarian  hormone,  to 
which  the  body  has  been  accustomed  for  perhaps  30  years, 
permits  compensatory  irregularities  on  the  part  of  the  other 
glands,  notably  the  adrenals,  and  many  times  the  hot  flushes 
and  the  circulatory  imbalance  are  related  to  a  considerable 
increase  in  the  systolic  blood-pressure. 
The  subject  has  been  given  consideration  elsewhere  (see 
Section  V,  Chapter  15)  and  to  make  a  long  story  short,  there 
is  indeed  an  organotherapeutic  measure  that  can  be  given 
with  prospects  of  results  in  these  cases.  It  consists  of  a 
small  dose  of  thyroid — a  remedy  known  to  have  a  depressor 
effect  in  certain  functional  high  blood-pressures  for  reasons 
which  are  discussed  in  my  paper  "Hypothyroidism,  Infil- 
tration and  Hypertension"  (Medical  Record,  Nov.  20, 
1920) ;  pancreas  for  its  equally  useful  depressor  influence 
which  is  believed  to  be  brought  about  in  two  ways — the 
one  by  its  antagonism  to  adrenal  irritability  and  the  other 
by  its  lessening  toxic  conditions  in  the  alimentary  canal — 
and  finally,  ovarian  substance  with  corpus  luteum. 

This  combination,  known  as  Thyro-Pancreas  Co.  with 
Ovary  (Narrower)  (No.  30  on  our  list)  may  be  given  with 
the  expectation  of  lessening  not  merely  the  high  blood-pres- 
sure but  some  of  the  associated  circulatory  difficulties  so 
common  at  this  period.  The  dose  is  five  grains,  four  times 
a  day,  and  in  certain  instances  after  a  short  period  of  treat- 
ment the  amount  may  be  doubled  for  a  month  and  there- 


390  PRACTICAL  ORGANOTHERAPY 

after  when  some  control  has  been  noted,  one  five-grain  dose 
three  or  four  times  a  day  will  suffice  to  continue  the  treat- 
ment for  a  total  of  at  least  three  months. 

I  know  of  really  spectacular  reductions  in  blood-pressure 
as  a  result  of  this  treatment.  A  case  comes  to  mind  of  a 
woman  who,  like  your  own  cases,  was  in  the  change  of  life, 
whose  blood-pressure  was  260  and  she  was  not  standing 
it  very  well  because  with  it  she  had  terrible  headaches 
which  were  very  disconcerting.  It  was  brought  down  ex- 
actly 100  points  in  three  months  and  the  last  record  that  I 
had  was  160-90. 

35.    THE  TONSILS  AND  THE  THYROID 

Query:  "Does  the  removal  of  the  tonsils  aid  in  the  treat- 
ment of  an  enlarged  thyroid  ?  Give  treatment." 

Answer:  Very  often  the  tonsils  are  responsible  for  thy- 
roid enlargement,  and  whenever  a  case  of  goitre  comes  to 
the  office  and  one  finds  that  the  tonsils  are  enlarged  and 
infected  or  that  there  is  an  inactive  infection  and  the  deep- 
ened crypts  contain  purulent  material,  in  my  estimation, 
the  tonsils  should  be  removed. 

Without  any  question,  the  absorption  of  poisons  from  the 
infected  tonsillar  tissue  stimulates  the  thyroid  and  is  a  fac- 
tor in  the  condition  about  which  you  ask.  There  are  many 
reports  in  the  literature  emphasizing  the  necessity  for  car- 
ing for  infected  tonsils  in  connection  with  goitre  and,  espe- 
cially, hyperthyroidism.  (See  the  first  issue  of  Harrower's 
Monographs  on  the  Internal  Secretions  and  especially  the 
chapter  on  "Focal  Infection"  in  the  section  on  diagnosis 
in  this  publication.) 

It  is  well  to  assure  oneself  of  the  character  of  the  thy- 
roid enlargement,  and  this  can  be  done  very  frequently 
by  the  local  examination  coupled  with  my  Thyroid  Function 
Test.  If  we  have  a  case  of  thyroid  irritability,  I  have  al- 
ready outlined  tiie  treatment  quite  fully  in  the  article  en- 
titled, "My  Routine  in  Hyperthyroidism."  (See  also  Sec- 
tion V,  Chapter  10.)  On  the  other  hand,  if  it  is  simple 
goitre  of  the  common  variety  and  involves  a  deficiency 
in  the  service  of  the  thyroid  of  the  body,  then 
my  best  suggestion  is  to  use  iodex  ointment  ex- 
ternally, a  piece  about  the  size  of  a  Lima  bean,  rubbed  upon 
both  sides  of  the  neck  every  night  and  No.  18  on  our  list, 
Iodized  Thyroid  Co.  (Harrower)  of  which  the  dose  usually 
is  one,  four  times  a  day.  This  formula  contains  iodid  of 


POINTS  ON  DOSAGE  391 

iron,  desiccated  thyroid  and  nucleinic  acid  (nuclein)  and  is 
an  excellent  remedy  for  simple  goitre. 

If  by  any  chance  the  thyroid  is  enlarged  because  of  an 
ovarian  dysfunction — and  this  is  quite  common — of  course 
it  will  be  necessary  to  take  care  of  this  simultaneously. 


36.    SOME  POINTS  ON  ENDOCRINE  DOSAGE 

Query:  "In  looking  over  the  dose  table  in  the  Appendix  to 
your  book,  "Practical  Organotherapy,"  I  note  a  wide  dis- 
crepancy in  the  dosage  of  various  substances.  Comparing 
the  dose  table  with  statements  in  the  various  formulae  and 
other  places  in  the  body  of  the  book  there  seems  to  be  quite 
a  little  difference.  Just  one  instance :  In  Gonad  Compound 
the  dose  of  pituitary  gland  (anterior  lobe)  is  given  as  1  Gr. 
(see  page  93),  while  the  dose  table  gives  the  dose  of  this 
substance  as  1/5  of  a  grain.  The  dose  table  also  gives 
the  dosage  of  thyroid  as  from  1/12  to  1/2  Gr.,  which  is  only 
a  fractional  dose  compared  to  some  recommendations." 

Answer:  I  am  sorry  that  there  has  been  some  misunder- 
standing to  prompt  your  query,  for  if  you  will  look  at  the 
table  again  you  will  see  in  the  first  column  (average  dose 
t.  i.  d.)  that  in  line  25  "pituitary-anterior"  is  given  as 
"1-5."  That  means  one  to  five  grains  per  dose  three  times 
a  day  and  not  one  fifth  of  a  grain  as  you  indicate.  If  you 
will  read  up  or  down  this  column  it  could  not  have  meant 
one  fifth  of  a  grain  because  the  first  item  on  the  list, 
"Adrenal  total,"  is  i/£-2  gr.,  and  the  last,  "Trypsin,"  1-5  gr. 

In  regard  to  what  it  is  claimed  is  a  mistake  about  the 
dose  of  thyroid  which,  as  you  recall,  is  given  as  one  twelfth 
to  one  half  a  grain:  I  admit  that  quite  a  number  are  in 
the  habit  of  giving  much  larger  doses  of  thyroicl  even  of 
the  desiccated  gland,  but  I  agree  with  them  only  under 
unusually  exceptional  circumstances.  Possibly  you  have  in 
mind  a  very  excellent  English  preparation  of  thyroid,  the 
dosage  of  which  is  based  upon  the  fresh  gland  represented 
in  each  tabloid,  and  you  will  recall  if  you  will  look  at  my 
dose  table  that  the  relation  of  dry  powder  to  the  fresh 
gland  in  the  case  of  Thyroid,  (U.  S.  P.),  is  as  one  to  six; 
that  is  to  say,  it  takes  six  parts  of  the  fresh  substance  to 
produce  one  of  the  dry,  and  naturally  this  makes  a  great 
deal  of  difference  in  the  actual  amount  of  thyroid  principle 
that  is  given  in  the  final  desiccation.  We  follow  the  U.  S.  P. 
and  all  our  products  are  dosed  upon  a  basis  of  desiccated 
substance  in  each  formula. 


392  PRACTICAL  ORGANOTHERAPY 

37.    ICHTHYOSIS  IN  A  BOY 

Query:  "I  have  a  case  with  a  scaly  condition  of  the  legs 
and  a  roughness  of  the  skin  on  the  forearms  in  a  boy  about 
seven  years  old.  This  has  been  called  ichthyosis  and  he  has 
had  it  most  of  his  life.  Which  of  your  preparations  would 
do  the  most  good  ?" 

Answer:  Fortunately,  true  ichthyosis  is  not  very  com- 
mon, but  a  roughened,  thickened,  scaly  skin  is  not  unusual 
in  thyroid  insufficiency,  the  more  especially  as  it  is  a  chronic 
condition  of  years  standing  in  a  child  only  seven  years  old. 

In  an  interesting  article  by  J.  M.  H.  MacLeod  of  the 
Charing  Cross  Hospital,  London,  (Practitioner,  London, 
Feb.  1915,  p.  298),  he  writes  under  the  subheading  "Xero- 
derma  and  Ichthyosis,"  in  the  following  words : 

"A  scaly  developmental  anomaly  such  as  ichthyosis  sug- 
gests itself  as  a  suitable  cutaneous  disorder  for  thyroid 
medication,  and  the  remedy  has  been  employed  in  this  con- 
nection with  favorable  results  in  a  considerable  number  of 
recorded  cases.  The  precise  condition  of  the  thyroid  in  ich- 
thyosis has  not  been  worked  out  definitely,  and  would  appear 
from  reports  to  be  inconstant;  but  clinical  examination  of 
the  thyroid,  especially  in  young  children,  is  almost  invariably 
unsatisfactory,  as  the  gland  is  difficult  or  impossible  to  de- 
tect by  palpation.  [Incidentally,  the  Thyroid  Function  Test 
had  not  come  into  use  at  that  time. — H.  R.  H.]  Winfield 
described  a  case  of  ichthyosis  in  a  child  who  lived  two  and 
a  half  weeks,  and  at  the  autopsy  the  thyroid  body  was 
found  to  be  absent.  Colcott  Fox  reported  a  case  of  ich- 
thyosis in  a  child  of  16  months  of  age,  which  improved 
under  the  ingestion  of  thyroid  extract,  and  in  whom  he  was 
unable  to  detect  any  thyroid  gland.  .  .  .  Up  to  the  pres- 
ent it  has  not  been  definitely  proved  that  the  thyroid  func- 
tioning is  constantly  defective  in  ichthyosis.  .  .  . 

"A  number  of  observers,  however,  have  found  that  definite 
benefit  followed  the  ingestion  of  thyroid  in  certain  cases  of 
xeroderma  and  mild  ichthyosis  in  children,  and  that  when 
thyroid  treatment  is  started  a  desquamation  takes  place, 
which  is  rapidly  followed  by  an  improvement,  the  skin  be- 
coming smoother  and  assuming  a  more  healthy  appearance. 
Unfortunately,  the  improvement  usually  ceases  when  the 
thyroid  treatment  is  discontinued,  and  a  relapse  is  liable 
to  take  place." 

The  Thyroid  Function  Test  is  quite  a  helpful  means  of 
determining  the  extent  of  the  thyroid  insufficiency,  but  it 


ORGANOTHERAPY  IN  CHOREA  393 

is  good  practice  to  apply  thyroid  therapy  without  this  test 
in  a  case  of  this  type.  On  the  general  principle  that  thyroid 
deficiencies  of  years  standing,  especially  in  growing  chil- 
dren, must  needs  have  involved  the  associated  glands,  it  is 
proper  to  consider  them  also  in  the  treatment,  and  Antero- 
Pituitary  Co.  (Harrower),  which  contains  in  addition  to  a 
small  dose  of  thyroid  suitable  amounts  of  the  anterior  pit- 
uitary substance  and  thymus,  would  be  a  reasonable  meas- 
ure. 

For  a  boy  of  this  type,  give  one  dose  three  times  a  day 
with  his  food.  At  the  end  of  a  month  if  there  have  been  no 
results,  add  to  the  same  treatment  of  thyroid,  y%  grain, 
one  dose  a  day,  as,  for  example,  in  our  No.  9  Thyroid  Co. 
(Harrower).  At  the  end  of  the  second  month,  provided 
the  results  are  not  complete,  continue  the  same  treatment 
but  give  two  half-grain  doses  of  thyroid  daily. 


38.    ORGANOTHERAPY  IN  CHOREA 

Query:  "Can  you  give  me  some  suggestions  as  to  the 
treatment  of  chorea  with  glandular  extracts?" 

Answer:  There  are  quite  a  number  of  references  in  the 
literature  to  a  possible  relationship  between  disturbed  func- 
tion of  the  endocrines  and  chorea.  Quite  a  number  of  chil- 
dren with  this  motor  difficulty  have  been  found  to  show 
simultaneously  evidences  of  glandular  dysfunction,  notably 
of  the  thyroid  and  parathyroid  glands.  Some  Italian  in- 
vestigators have  emphasized  the  relationship  between  tet- 
any  and  the  convulsive  manifestations  that  are  connected 
with  hypoparathyroidism  and  chorea,  and  there  are  four 
or  five  papers  in  Italian  medical  literature  speaking  highly 
of  parathyroid  therapy  as  of  prospective  merit  in  the  treat- 
ment of  chorea,  especially  when  it  is  combined  with  calcium 
salts  (since  parathyroid  dystrophies  usually  are  related  to 
disturbances  of  the  calcium  metabolism). 

From  the  standpoint  of  the  thyroid  gland  the  French  have 
been  most  active  in  their  study  and  several  writers  empha- 
size the  importance  of  considering  the  thyroid  aspect  of 
every  child  with  chorea,  and,  if  there  is  evidence  of  dys- 
thyroidism  these  writers  naturally  urge  the  control  of  this 
condition  as  well  as  the  treatment  of  the  chorea. 

Personally,  I  do  not  think  that  chorea  is  essentially  an 
endocrine  disease.  When  it  is  found  in  conjunction  with 
dyscrinism  or  disturbed  function  of  one  or  more  of  the 
glands  of  internal  secretion,  naturally  the  treatment  should 


394  PRACTICAL  ORGANOTHERAPY 

include  measures  directed  at  the  endocrine  trouble,  or  or- 
ganotherapy. 

In  developmentally  defective  children  in  whom  chorea  is 
one  of  the  manifestations,  Antero-Pituitary  Co.  (Har- 
rower)  should  be  given.  This  may  be  supplemented  by  para- 
thyroid if  it  is  desirable  and  occasionally  the  results  will  be 
encouraging.  Peculiarly  enough,  as  your  letter  was  on  my 
desk  for  this  reply  a  physician  called  in  to  consult  me  and  in 
his  conversation  he  told  of  a  case  of  chorea  in  a  child  of 
eleven  that  was  virtually  cured  entirely  by  this  particular 
formula,  and  nothing  else.  This,  of  course,  is  not  usual 
and  I  do  not  want  you  to  feel  that  I  am  recommending  this 
method  of  treatment  for  the  chorea  itself,  but  rather  for 
the  underlying  dysfunction  which  is  so  often  found  in  chil- 
dren who  are  not  normal  in  regard  to  their  endocrine  devel- 
opment. Our  Parathyroid  Co.  (Harrower)  might  be  used 
experimentally  in  chorea  in  conjunction  with  the  above. 

As  this  goes  to  the  printer  I  am  in  receipt  of  a  letter 
from  a  physician  in  Missouri  who  had  consulted  me  some 
months  ago  about  a  complicated  case  with  chorea.  It  is 
an  interesting  report — and  friendly: 

"You  may  remember  the  case  of  the  14-year-old  girl  I 
wrote  you  about  early  in  August.  Well,  I  am  proud  to  say, 
she  is  steadily  improving  and  the  parents,  who  formerly 
had  lost  all  hope  after  years  of  trial  in  various  cities  under 
seemingly  all  pathies  and  forms  of  treatment,  are  now  in 
the  seventh  heaven  of  delight  at  the  rapid  changes  for  the 
better  in  her  condition.  I  am  sending  now  for  the  third 
package  of  Antero-Pituitary  Co. 

"The  choreic  conditions  are  disappearing  fast  and  she 
now  walks  perfectly  erect  and  goes  up  and  down  stairs 
without  assistance  as  well  as  you  or  I.  Appetite,  sleep, 
bowels  and  kidneys  all  good—speech  is  difficult  yet  and  the 
ligaments  of  the  left  arm  still  are  heavily  contracted,  but 
the  general  atrophy  of  the  limbs  and  the  facial  expression 
are  approaching  rapidly  to  normal.  Congratulations,  Mon 
ami!" 


39.    LATENT  TUBERCULOSIS 

Query:  "You  state  that  'the  endocrines  are  involved  in 
every  case  of  tuberculosis'.  Perhaps  you  are  right.  What 
about  these  glands  in  the  early,  latent  cases?  I  should  think 
that  the  best  time  to  get  after  the  glands  is  early.  Give 
us  some  points  about  it." 


LATENT  TUBERCULOSIS  395 

Answer:  The  earlier  the  better.  I  am  convinced  that  the 
earliest  beginnings  of  the  so-called  "pre-tuberculosis  stage" 
are  connected  with  endocrine  depletion.  A  severe  illness, 
infected  pair  of  tonsils  or  the  proverbial  "bad  cold"  always 
involve  these  endocrine  regulators.  It  cannot  well  be  other- 
wise. Some  very  frank  and  pointed  consideration  was  given 
to  this  very  subject  by  my  friend,  Dr.  0.  W.  McMichael,  of 
Chicago,  in  an  article  published  in  the  New  York  Medical 
Record  for  February  21,  1910  (page  317) .  This  is  an  un- 
usually virile  article  and  the  author,  well  trained  in  the 
school  of  experience  with  these  cases,  hits  straight  from 
the  shoulder  in  regard  to  poor  diagnosis,  faddism,  and  the 
really  important  factors  which  are  involved  in  latent  tuber- 
culosis and  commonly  overlooked. 

This  reference  to  McMichael's  excellent  article  is  made  in 
order  to  note  the  following  unusually  accurate  word-picture 
of  this  condition:  "The  tired  school  girl  is  brought  to  us 
because  she  cannot  keep  up  with  her  work.  She  is  tired  all 
of  the  time.  She  has  not  lost  weight,  she  always  was  thin, 
just  like  her  father,  who  always  was  thin  and  who,  by  the 
way,  is  carrying  around  in  his  chest  an  old  tuberculous  cav- 
ity that  no  one  knows  about,  though  they  do  say  he  was 
threatened  with  lung  trouble  when  he  was  a  young  man. 
She  has  no  cough  so  we  do  not  look  at  her  chest.  We  do 
notice  that  her  thyroid  is  a  little  larger,  but  many  girls  at 
puberty  have  enlarged  thyroids.  She  is  just  run  down,  so 
we  prescribe  a  tonic,  whatever  that  is.  She  picks  up 
again,  and  in  two  or  three  years  she  is  sent  to  a  sanatorium. 
We  do  not  see  that  that  enlarged  thyroid  meant  a  response 
to  a  cry  for  help.  We  did  not  know  that  the  blood  was 
burdened  with  an  excess  of  tubercle  toxins,  that  the  adrenal 
glands  were  unable  to  meet  the  burden  of  controlling  elim- 
ination and  telegraphed  the  pituitary  body,  which  in  turn 
whipped  up  the  thyroid.  Disturbance  of  endocrine  balance 
is  a  result  of  toxemia.  Tubercle  toxemia  is  constantly  pres- 
ent in  varying  degree  in  latent  tuberculosis.  Lowered  blood 
pressure  is  a  constant  sign  of  tubercle  toxemia." 

The  "cry  for  help"  to  which  this  author  so  aptly  directs 
attention  is  extremely  important,  and  its  importance  is  in 
direct  proportion  to  the  frequency  with  which  this  phase  of 
tuberculosis  is  ignored.  Adrenal  insufficiency  is  the  most 
common  endocrine  disturbance  in  tuberculosis  and  is  be- 
lieved by  many  to  be  the  direct  cause  of  the  low  blood-pres- 
sure, the  marked  asthenia,  the  poor  elimination  of  urinary 
solids,  as  well  as  the  subnormal  temperature.  It  is  begin- 


396  PRACTICAL   ORGANOTHERAPY 

ning  to  be  fairly  well  known  by  my  readers  that  I  am  con- 
vinced that  Adreno-Spermin  Co.  (Harrower)  is  an  efficient 
means  of  antagonizing  just  this  condition — but  it  does  not 
cure  the  tuberculosis !  It  merely  helps  to  take  care  of  a  very 
obvious  deficiency  which  certainly  ought  to  be  taken  care  of 
in  conjunction  with  other  lines  of  treatment  necessary  to 
help  these  poor  people. 


40.     SUBNORMAL  TEMPERATURE 

Query:  "A  number  of  my  patients,  especially  those  who 
have  had  tuberculosis  and  are  in  the  arrested  stage,  have 
a  noticeably  reduced  temperature.  It  varies  from  92  (in  an 
extreme  case)  to  97  and  usually  averages  about  96.  Is  this 
related  to  the  ductless  glands  and  is  there  not  some  chance 
for  organotherapy?" 

Answer:  A  subnormal  temperature  is  one  of  the  expected 
findings  in  adrenal  insufficiency.  In  many  items  that  I  have 
written,  reference  to  the  subnormal  temperature  is  coupled 
with  a  poor  elimination  of  urea  in  the  24-hour  urine,  a 
lessened  systolic  blood-pressure,  marked  asthenia,  and  mal- 
nutrition— in  other  words,  everything  is  "below  par".  The 
same  thing  is  true  in  cases  of  hyppthyroidism  and  not 
merely  is  there  an  actual  reduction  in  the  production  of 
heat  but  the  patient  feels  very  cold,  the  circulation  is  poor 
(impeded  by  the  infiltration  so  common  in  these  cases)  and 
the  temperature  naturally  is  a  degree  or  two  below  normal. 

In  neurasthenia,  following  severe  infectious  diseases  and 
especially  in  the  post-influenzal  state,  a  subnormal  tempera- 
ture is  very  common  and  in  most  instances  it  will  be  found 
in  conjunction  with  a  thyro-adrenal  insufficiency.  In  many 
instances  the  lowered  temperature  may  be  raised  and  there 
is  a  general  increase  in  well-being  and  circulatory  activity 
following  the  application  of  adrenal  support  in  the  manner 
which  I  have  suggested  many  times. 

In  tuberculosis,  particularly,  hypoadrenia  is  common. 
This  has  been  referred  to  in  several  articles  from  my  pen 
(see  Sec.  V,  Chap.  2,  and  Sec.  VI,  Chaps.  32  and  39.) 

In  cases  with  a  sub-normal  temperature,  it  is  quite  inter- 
esting to  estimate  the  B.  M.  R.  (basal  metabolic  rate) .  Many 
of  these  individuals  have  a  basal  metabolic  rate  which  is  10, 
20  or  even  25  per  cent  below  the  normal.  The  reason  for  the 
lowered  metabolism  is  identical  with  the  reason  for  the 
lowered  temperature — endocrine  insufficiency;  and  whether 
it  is  purely  of  thyroid  origin,  as  in  certain  cases,  or  a  pluri- 


SUBNORMAL  TEMPERATURE  397 

glandular  proposition,  as  I  believe,  does  not  change  this 
particular  finding. 

I  have  on  my  desk  the  records  in  a  case  referred  to  me 
of  a  woman  in  the  thirties  whose  weight  was  only  61  pounds 
with  her  clothes  on !  In  the  investigation  which  I  initiated, 
her  B.  M.  R.  was  -19.7  per  cent,  and  her  temperature  was 
96.2  Fahrenheit  or  at  least  two  degrees  below  normal  tem- 
perature. It  happens  that  Du  Bois  and  his  associates  re- 
cently have  shown  quite  accurately  that  the  B.  M.  R.  is 
changed  about  seven  points  by  each  degree  of  reduction  in 
body  temperature.  Therefore,  in  this  case  with  the  tem- 
perature two  degrees  below  normal,  one  could  expect  at 
least  a  rate  of  -14,  where  in  reality  it  was  -19. 

Very  often  these  individuals  with  a  subnormal  tempera- 
ture are  not  eating  enough,  and  if  they  are  studied  from  the 
standpoint  of  the  calorific  amount  of  food  consumed,  some 
interesting  things  may  be  developed. 

In  these  cases  the  encouragement  of  the  undoubtedly  lag- 
ging endocrine  glands,  plus  other  methods  calculated  to  in- 
crease oxidation,  and  the  supplying  of  the  needed  heat  pro- 
ducing foods,  may  make  a  very  noticeable  difference;  and, 
by  the  way,  in  many  instances  of  tuberculosis  where  the 
temperature  was  decidedly  subnormal  and  where  there  was 
a  considerable  degree  of  asthenia,  previous  good  treatment 
was  made  better  by  the  application  of  the  principle  of 
adrenal  support  just  mentioned. 


SECTION  VH 

APPENDIX 
1.  A  GLOSSARY  OF  TERMS 


A  number  of  terms  which  are  not  in  general  use  neces- 
sarily insinuate  themselves  into  a  book  of  this  character. 
Some  of  them  are  not  found  in  the  late  dictionaries.  Of 
course,  the  list  cannot  pretend  to  be  complete,  but  at  the 
suggestion  of  a  number  of  readers  of  the  first  two  editions 
this  addition  is  made  to  the  appendix  in  the  hope  that  it 
may  be  especially  helpful  to  many. 

Activator.  A  substance  which  changes  a  ferment  from 
an  inactive  to  an  active  form.  Ex.:  HC1  activates  pepsino- 
gen  as  secreted  by  peptic  glands  to  pepsin. 

Adrenalin.  The  trade  name  for  the  pressor  principle  of  the 
adrenals,  isolated  by  Takamine.  The  hydrochloride  in  1  in 
1,000  solution  is  used  generally. 

Adrenin.  A  short,  euphonious,  physiological  term  for  the 
adrenal  medullary  principle,  preferred  by  Cannon  and  other 
authorities  to  adrenalin  and  epinephrin  (q.  v.) 

Alpha-Iodin.  E.  B.  Kendall's  first  name  for  the  essential 
thyroid  principle.  See  Thyroxin. 

Antihormone.  A  chalone  or  antagonistic  hormone;  name 
given  first  to  the  internal  secretion  of  the  pancreas,  because 
of  its  action  upon  the  adrenal  or  chromaffin  hormone. 

Asthenia.  Lack  of  strength  and  vitality ;  the  fatigue  syn- 
drome. 

Autacoid.  (Greek,  self;  a  remedy).  A  generic  term  sug- 
gested by  Sir  E.  A.  Schafer  to  include  all  the  chemical  mes- 
sengers— i.  e.,  hormones  and  chalones  (q.  v.) 

Basal  Metabolism.  Energy  metabolism  determined  ca- 
lorimetrically  from  fourteen  to  eighteen  hours  after  eating 
and  when  the  individual  is  at  complete  rest. 

B-iminazolylethylamine.  A  depressor  and  utero-stimu- 
lant  amine  prepared  from  histidine  (and  therefore  also  from 
intestinal  extracts)  by  the  action  of  putrefactive  bacteria. 

B.  M.  R.    Abbreviation  for  "basal  metabolic  rate." 

Cachexia.  Malnutrition  in  cancer  and  other  serious  toxic 
diseases.  (Found  to  be  result  of  hypoadrenia.) 

399 


400  PRACTICAL  ORGANOTHERAPY 

Chalone.  (Greek,  I  relax).  A  term  suggested  by  Sir  E^ 
A.  Schafer  to  indicate  the  hormones  which  do  not  excite — 
the  antagonistic  hormones.  Ex.:  the  "Langerhansian  hor- 
mone." 

Chemasthenia.  A  term  intended  to  refer  to  deficient 
metabolism  "asthenic  chemistry"  as  compared  with  myas- 
thenia,  neurasthenia,  cardiasthenia,  etc.  See  endocrine 
asthenia. 

Chemical  reflex.  Another  term  for  "humoral  reflex" 
(<?.  v.) 

Chromaffin.  Staining  with  chromic  acid  or  its  salts.  A 
term  applied  to  the  adrenal  medulla  and  its  hormone — i.  e. 
the  chromaffin  hormone. 

Coenzyme.  A  substance  which  manifests  a  cooperative 
activity  between  an  enzyme  and  some  other  non-colloidal 
substance.  Ex.:  The  influence  of  bile  salts  on  pancreatic 
lipase.  The  process  differs  from  activation,  for  the  com- 
bination is  dissociable  instead  of  permanent.  A  coenzyme 
can  be  separated  from  an  enzyme  by  dialysis. 

Cretinism.  Major  hypothyroidism  in  children  corre- 
sponds to  the  acquired  myxedema  in  adults. 

Demineralization.  A  condition  in  which  there  is  a  de- 
ficient mineral  content  of  the  blood  and  tissue  juices;  less- 
ened alkaline  reserve;  acidemia;  etc. 

Dyscrinism.  Disordered  function  of  the  endocrine  glands 
as  a  whole.  (Also  called  "dysendocrinism.") 

Endocrine  (Greek,  within,  internal;  I  separate,  set  apart), 
Pertaining  to  the  internal  secretions.  Occasionally  written 
"endocrinous".  (Both  words  are  philological  monstrosities. 
In  Greek  a  verb  can  be  compounded  directly  only  with  a 
preposition.) 

Endocrine  Asthenia.  An  asthenic  condition  of  the  en- 
docrine  glands ;  also  an  asthenic  condition  brought  about  by 
hypocrinism  including  chemasthenia,  myasthenia,  neuras- 
thenia, cardiasthenia,  etc. 

Endocrinosis.    An  endocrine  neurosis. 

Epinephrin.  The  term  given  by  Abel  to  the  active  pres- 
sor  principle  of  the  adrenal  gland.  Used  erroneously  by 
some  to  indicate  all  adrenal  preparations,  irrespective  of 
their  origin. 

Gonads.  The  essential  sex  glands — i.  e.,  the  testes  and  the 
ovaries. 

Histo therapy  (Greek,  tissue).  A  term  rarely  used  instead 
of  opotherapy  (q.  v.) 


GLOSSARY  401 

Homostimulant.  A  term  used  to  indicate  the  particular 
action  which  organic  extracts  and  lipoids  exert  upon  the 
organs  to  which  they  correspond. 

Homostimulate.  Self-stimulate,  i.  e.,  the  stimulation  of 
cells  corresponding  to  those  from  which  the  homostimulant 
(q.  v.)  is  secured. 

Hormone.  A  chemical  messenger,  which,  formed  in  one 
organ,  travels  in  the  blood-stream  to  the  other  organs  of  the 
body,  and  effects  a  correlation  between  the  activities  of  the 
organ  of  origin  and  the  organs  on  which  they  exert  their 
specific  effect.  Ex.:  secretin  (in  duodenum)  activates  the 
pancreatic  cell  and  changes  the  inert  pancreatic  protryp- 
sinogen  to  trypsinogen,  ready  for  use  as  soon  as  it  reaches 
the  intestine  (and  in  this  case  further  activated  by  enter- 
okinase) . 

Humoral  reflex.  The  activity  brought  about  through  the 
blood  and  the  hormone  contents  of  its  plasma  (as  compared 
with  the  nerve  reflex) . 

Hyperendocrinism.  The  opposite  of  hypoendocrinism ; 
not,  however,  clinically  known.  (Should  be  hyperendocrisia; 
see  note  on  Endocrine.) 

Hypocrinism.  A  short  and  more  frequently  used  term 
for  hypoendocrinism.  (q.  v.) 

Hypoendocrinism.  Deficient  internal  secretory  activity; 
usually  refers  to  pluriglandular  insufficiencies,  as  special 
words  (hypopituitarism,  hypothyroidism,  etc.)  are  applied 
to  individual  deficiencies. 

Hypoplasia.  In  this  book,  particularly,  a  deficient  growth 
and  development. 

Hyposphyxia,  A  syndrome  described  by  Martinet  in 
which  there  is  a  semi-asphyxia  of  the  cells  due  to  hypoten- 
sion, venous  stasis  and  circulatory  inefficiency.  Believed 
to  be  largely  of  adrenal  origin. 

Infundibulum.    The  posterior  lobe  of  the  pituitary  body. 

Interstitial  gland.    See  Leydig  cells.  1 

Interrenals.  The  adrenal  cortex  (as  opposed  to  the 
adrenal  medulla.)  In  some  fishes  they  are  separate  organs. 

Leydig  Cells.  The  essential  internal  secretory  cells  of 
the  male  gonads ;  the  interstitial  gland. 

Myxedema.  An  acquired  thyroid  insufficiency  of  consid- 
erable degree ;  major  hypothyroidism. 

Myxedeme  fruste.  Hertoghe's  disease;  a  latent  but  well- 
defined  form  of  hypothyroidism. 

26 


402  PRACTICAL  ORGANOTHERAPY 

Neuro-circulatory  Asthenia.  A  term  originated  during 
the  war  to  indicate  a  syndrome  which  is  believed  to  be  due 
to  endocrine  asthenia.  Usually  found  associated  with  hypo- 
crinism. 

Parhormone.  Products  of  katabolism  endowed  with  a 
physiological  or  hormone-like  action  (Gley).  See  Ponogen. 

Pluriglandular.  A  term  used  to  indicate  a  form  of  com- 
pound glandular  therapy — i.  e.,  the  simultaneous  adminis- 
tration of  several  extracts. 

Polyglandular.  A  word  of  mixed  derivation  which  should 
not  be  used.  See  Pluriglandular. 

Ponogen.  (Greek,  work).  A  cellular  waste  which  may 
serve  as  a  "chemical  messenger"  to  influence  some  remote 
organ  (Laumonier) .  See  Parhormone. 

Prosecretin.  The  precursor  of  secretin,  found  in  the  duo- 
denal walls  and  changed  or  activated  to  secretin  by  hydroly- 
sis with  action  of  HCI. 

Remineralization.  The  treatment  of  demineralization 
(q.  v.)  by  means  of  suitable  alkaline  tissue  salts. 

Secretin.  The  typical  hormone  from  the  duodenal  mucosa 
secreted  as  prosecretin,  and  later  activated  by  HCI.  (1) 
Pancreatic  secretin:  the  secretin  which  activates  the  pan- 
creatic cells;  not  secretin  from  the  pancreas.  (2)  Gastric 
secretin :  the  secretin  which  activates  the  gastric  cells. 

Sequardotherapy.  A  little-used  term  for  opotherapy 
(q.  v.),  based  on  the  name  of  the  "discoverer  of  animal 
therapy" — Brown-Sequard. 

Spermin.  A  definite  chemical  body  obtained  from  the 
testicles,  said  to  be  a  nerve  tonic  and  cell  stimulant  (von 
Poehl,  Petrograd). 

Stimulin.  A  term  sometimes  wrongly  used  in  the  place 
of  "hormone".  Stimulins  are,  according  to  Metchnikpff, 
certain  protective  bodies  in  blood-serum,  which  produce  im- 
munity when  inoculated  by  stimulating  phagocytic  action. 

Tethelin.  The  active  principle  of  the  anterior  lobe  of  the 
pituitary  body  isolated  by  T.  Brailsford  Robertson,  of 
Berkeley. 

Thyroxin.  Trade  name  for  alpha-iodin,  the  recently-dis- 
covered crystalline  iodin  containing  active  principle  of  the 
thyroid  gland. 

Vitamine.  Evidently  a  plant  hormone,  e.  g.,  the  life-en- 
couraging, nutrition-stimulating,  growth-developing  plant 
principle. 


DOSE  TABLE 


2.     DOSE  TABLE 


4U3 


Preparation 

Aver.  Dose 
t.  i.  d. 

Rel.  Dry  to 
Fresh 

Compar. 
Cost 

Adrenal  (total) 

i/>-2  gr. 

1:6 

2 

Adrenal  Cortex 

2-5 

9 

Adrenal  Medulla  

3-10  m. 

1:20M 

1200 

Amylopsin  

2-10 

1:8 

1-5 

Bile  Salts  

1-5 

1:40 

1 

Bone  Medulla  

1-2  dr. 

3 

Brain  Substance  

5 

1:6 

1 

Corpus  Luteum 

2-5 

1:5 

10 

Duodenal  Scrapings 

5-10 

1:12 

1 

Hemoglobin  

3-5 

2 

Kidney  

5-15 

1:8 

2 

Lecithin       

3 

Liver  

5-15 

1:6 

1 

Lung 

10-20 

1:10 

1 

Lymphatic 

1-5 

1:5 

3 

Mammary  . 

3-10 

2 

Nuclein  . 

3 

Ovary  (total)  . 

2-5 

l:6Vo 

2 

Pancreas  (gld.)  

2-10 

1:5 

1 

Pancreatin 

2-5 

1:8 

1-5 

Parathyroid  . 

1/50-1/20 

1  :5-5 

60 

Parotid  

2-8 

1:5 

1 

Pepsin  

3-10 

2-5 

Pineal  

1/10-1/2 

1:7 

40 

Pituitary  (anterior)  

1-5 

1:5 

7-5 

Pituitary  (total) 

1  :4V2 

9 

Pituitary  (posterior)  ..... 
Pituitary  (post,  prin.)  
Placenta  

1/10-1/2 
3-15  gt. 
3-5 

1:4 
1:61/2 

15 

800 
3 

Prostate  ..  . 

3-5 

1:6 

3 

Spermin  (Leydig  cells)  . 
Spleen  

2-3 
3-10 

1:9 

5 
1 

Steapsin  . 

2-5 

4 

Submaxillarv 

2-5 

1:8 

3 

Testes  (orchid)  

3-10 

1-5 

Thromboplastin 

4 

Thymus  

3-5 

1:61/2 

2 

Thyroid   

1/12-1/2 

1:6 

2-5 

Tonsil  

1/2-1 

1:7 

5 

TrvDsin  .. 

1-5 

fi 

Note;    For  explanation  of  the  above  table  see  page  404. 


404  PRACTICAL   ORGANOTHERAPY 

Explanation.  The  dosage  is  in  grains  except  where  other- 
wise stated,  and  the  amounts  given  are  approximate.  They 
may  be  repeated  three  or  more  times  a  day.  The  relation 
between  a  finished  desiccation  and  the  original  fresh  glandu- 
lar parenchyma  is  stated  as  accurately  as  possible  here, 
special  attention  is  called  to  this  as  certain  trade  products 
are  dosed  on  a  basis  of  "fresh  gland  substance,"  obviously 
to  the  detriment  of  convenience  and  even  safety.  All  the 
above  doses  are  based  upon  finished  products  and  follow  the 
U.  S.  Pharmacopeia  in  the  few  instances  where  gland  "ex- 
tracts" are  listed  therein,  and  is  based  upon  a  factor  called 
"1"  which  represents  the  cost  of  the  less  expensive  desic- 
cations such  as  spleen,  liver,  etc.  Where  an  occasional 
product  is  not  dry,  as  bone  marrow,  thrpmboplastin,  "Liq. 
Hypophysis"  (posterior  principle  of  the  pituitary)  naturally 
no  figures  can  be  given  in  the  fourth  column. 


3.    THE  "SANITABLET" 


It  happens  that  glandular  desiccations  are  decidedly  hy- 
groscopic and  if  exposed  to  moisture  darken  in  color,  becom- 
ing malodorous  and,  from  the  standpoint  of  appearances, 
are  spoiled.  (So  far  as  I  know  these  physical  changes  do 
not  destroy  the  therapeutically  active  principles.) 

Gelatine  capsules  are  also  hygroscopic  and  a  certain  de- 
gree of  humidity  will  cause  them  to  "melt".  As  a  result  of 
these  two  factors  we  frequently  have  found  ourselves  in 
trouble,  especially  in  certain  climates,  and  I  have  spent  a 
great  deal  of  time  and  money  in  an  attempt  to  overcome 
these  difficulties.  I  am  glad  to  be  able  to  say  that  they 
have  been  overcome  entirely. 

The  New  Package.  We  now  supply  my  pluriglandular 
formulas  as  "Sanitciblets" — compressed,  friable  tablets, 
packed  by  the  Sanitape  machine  leased  from  the  Ivers-Lee 
Company  of  Newark,  N.  J.  Each  dose  is  individually 
wrapped  and  hermetically  sealed  in  strips.  They  are  put  up 
in  small  cartons  of  20  doses,  5  cartons  to  the  package,  or 
100  Sanitablets  in  all.  The  word  "Sanitablets"  is  original 
with  me  and  is  protected  by  registration  in  the  U.  S.  Patent 
Office,  November  22,  1921. 

The  Sanitablet  is  never  touched,  and  the  waxed  wrapper 
makes  it  moisture-proof  and  air-tight.  It  is  the  best  pre- 
ventive of  deterioration  that  can  be  imagined,  and  the  ad- 


THE  SANITABLET  405 

vantages  of  this  are  particularly  obvious  in  tropical,  humid 
countries.  I  am  assured,  for  instance,  that  supplies  sent  to 
India,  reaching  there  and  being  used  during  the  tremend- 
ously damp  "monsoon  season"  were  in  perfect  order — a 
thing  which  would  be  quite  impossible  with  the  gelatine 
capsules. 

This  package,  which  has  been  in  use  for  nearly  a  year, 
also  favors  the  dispensing  of  smaller  amounts  than  100 
doses,  if  desired,  without  inconvenience  or  loss — since  each 
unit  of  20  Sanitablets  is  boxed  separately.  This  package 
is  also  quite  a  convenience  from  the  standpoint  of  the  pa- 
tient, since  each  dose  may  be  detached  without  touching 
the  Sanitablet,  or  several  doses  can  be  torn  off  and  slipped 
into  the  pocket  or  purse  and  carried  sealed  until  they  are 
taken. 

Prevents  Unfair  Competition.  Still  another  great  advan- 
tage lies  in  the  fact  that  this  package  effectually  prevents 
substitution.  Unfortunately,  many  inferior  substitutions 
have  been  palmed  off  for  real  Harrower  products.  It  is 
easy  to  fill  similar  capsules  and  the  temptation  is  strong 
and,  unfortunately,  many  have  succumbed  to  it  with  detri- 
ment to  our  own  reputation  because  numerous  letters  in- 
dicate that  these  substitutes  did  not  accomplish  what  has 
been  expected  from  the  original  products. 

For  instance,  a  Denver  physician  who  had  been  using  our 
preparations  for  some  years  had  several  cases  who  seemed 
to  be  progressing  nicely  on  the  use  of  Thyro-Ovarian  Co. 
(Harrower) .  As  many  physicians  know,  it  is  necessary  to 
continue  the  use  of  this  particular  formula  for  several 
months  and  not  infrequently  a  patient  will  use  from  three 
to  four  hundred  doses.  Within  a  week  this  physician  heard 
from  three  of  the  patients  that  "the  capsules  do  not  seem 
to  be  the  same  as  before  and  they  are  not  doing  as  much 
good",  or  words  to  that  effect.  The  coincidence  prompted 
the  physician  to  make  an  investigation.  He  secured  some 
of  the  capsules  presumed  to  be  of  our  manufacture  and 
when  analyzed  they  were  found  to  contain  a  generous  quan- 
tity of  an  excipient  not  used  by  The  Harrower  Laboratory- 
indicating  without  a  doubt  that  a  substitution  had  been 
made.  If  this  physician  had  not  been  thoroughly  converted 
to  the  value  of  these  preparatons  and  thus  a  friend  of  our 
work  and  of  organotherapy,  he  might  have  come  to  the  con- 
clusion that  we  were  dishonest  in  not  adhering  to  my  orig- 
inal, effective  formulas.  Indeed,  it  was  with  this  in  mind 
that  he  corresponded  with  us. 


406  PRACTICAL  ORGANOTHERAPY 

To  illustrate  this  further,  I  recall  a  recent  communication 
from  South  America  referring  to  a  certain  lady  who  had 
been  using  No.  6,  Pancreas  Co.  (Harroiuer)  with  very  con- 
siderable improvement  over  a  period  of  several  months.  The 
supply  was  low  and  diminished  until  it  was  necessary  to  go 
without  the  preparaton  for  seven  or  eight  weeks,  because 
of  the  fact  that  our  business  in  South  America  is  of  no 
large  proportions  and  we  are  not  represented  there.  A 
physician  in  Buenos  Aires,  having  access  to  the  second  edi- 
tion of  this  book,  and  knowing  that  the  formula  consisted 
of  an  apparently  simple  mixture  of  "Adrenal  and  Pituitary 
glands  (total)  aa  gr.  i/2»  Ovarian  substance  gr.  1,  Pancreas 
gland  (total)  gr.  3,"  (see  page  57),  thought  he  could  very 
conveniently  secure  these  products  locally  and  compound  a 
formula  very  closely  similar  to  mine,  but  "the  patient  did 
not  seem  to  do  as  well  on  this  formula,  in  fact,  it  must  have 
been  quite  different  from  the  preparation  she  had  been 
taking  previously";  indicating  to  my  mind  that  there  is 
perhaps  indeed  an  advantage  in  going  to  the  expense  and 
trouble  to  which  we  go  to  prepare  the  very  best  prepara- 
tions in  our  special  line  that  it  is  possible  for  us  to  pro- 
duce. 

The  Sanitablet,  therefore,  prevents  deterioration,  favors 
convenience  and  obviates  substitution  and  imposition  on  the 
doctor,  the  patient  and  on  me. 

Favorably  Accepted.  The  reception  of  this  innovation  in 
packing  has  been  very  encouraging  and  has  elicited  numer- 
ous favorable  comments.  As  was  to  be  expected,  some 
physicians  have  felt  that  it  was  unwise  and,  as  one  ex- 
pressed it,  that  "the  new  form  does  not  look  so  professional 
as  the  capsule".  I  have  also  heard  that  some  physicians 
evidently  have  been  giving  the  impression — quite  properly, 
perhaps — that  the  particular  products  they  were  prescribing 
were  made  up  for  each  particular  patient,  and  now  this  fic- 
tion cannot  be  maintained.  This,  of  course,  is  to  be  regret- 
ted. However,  I  cannot  avoid  the  conclusion  that  the  Sam- 
tape  idea  has  revolutionized  the  possibilities  of  our  work  and 
has  obviated  entirely  the  three  chief  obstacles  already  men- 
tioned with  which  we  have  had  to  contend. 

(For  some  time,  at  least,  we  shall  continue  to  supply 
directly  from  this  office  any  of  our  formulas  in  gelatine  cap- 
sules; and  where  comparatively  small  amounts  or  special 
formulas  not  regularly  listed  are  desired,  naturally  these 
will  be  put  up  in  the  same  "No.  One"  gelatine  capsules  as 
previously.) 


OUR  ETHICAL  STATUS  407 

4.    OUR  ETHICAL  STATUS 


From  the  inception  of  my  work  I  have  attempted  to  ad- 
here as  closely  as  possible  to  the  standards  of  ethics  ac- 
cepted by  the  majority  of  the  medical  profession.  We  have 
had  no  trade  names,  and  every  effort  has  been  made  to  ex- 
plain our  work  and  pass  on  information  on  the  subject  as  a 
whole  to  the  profession.  We  make  no  secret  remedies,  and 
have  opened  to  the  profession  our  complete  formulas.  There 
are  no  indications  on  the  labels.  There  is  no  promotion  lit- 
erature in  the  packages.  Every  effort  has  been  made  to 
conserve  the  professional  and  ethical  aspects  of  both  medi- 
cine and  pharmacy. 

Technical  Correspondence.  Quite  a  large  correspondence 
of  a  technical  nature  comes  to  my  desk  and  to  my  medical 
assistants — for  there  is  indeed  much  more  along  this  line 
than  I  can  possibly  attend  to  alone.  Such  correspondence 
is  welcome,  but  we  refuse  to  communicate  with  the  laity. 
It  is  impossible  to  practice  medicine  by  correspondence  and 
accurately  to  determine  conditions  as  they  may  be  at  a  dis- 
tance. It  is  a  common  thing,  however,  to  be  able  to  gather 
sufficient  information  from  a  letter  written  by  a  physician 
which  embodies  the  essential,  clinical  points,  and  with  these 
in  mind  to  be  able  to  make  recommendations  intelligently 
to  the  physician  to  aid  in  determining  the  endocrine  aspects 
of  the  case  in  question.  On  the  other  hand  the  patients 
themselves  cannot  appreciate  the  technical  aspects  of 
what  we  are  doing  and  it  is  absolutely  necessary  to  deny 
them  the  opportunity  of  getting  in  touch  with  us  directly. 

Occasionally  a  layman  writes  to  this  office  stating  that  he 
is  doing  so  on  the  recommendation  of  a  certain  physician 
whose  name  is  given.  Under  such  circumstances  our  policy 
is  to  acknowledge  the  letter,  give  such  suggestions  as  may 
occur  to  us,  and  at  the  same  time  communicate  with  the 
physician  whose  name  is  mentioned,  enclosing  a  carbon  copy 
of  the  letter  to  the  patient.  Frequently  a  patient  writes 
to  us,  prompted  by  results  that  have  been  secured  by  some 
remote  physician  in  the  case  of  a  friend,  and  under  such 
circumstances  we  have  to  insist  that  our  dealings  be 
through  some  physician  in  their  own  town  who  may  be 
acquainted  with  our  work  or,  rarely,  it  may  be  necessary  to 
acquaint  someone  with  our  work  in  order  to  enable  us  to 
adhere  to  our  rule  and  at  the  same  time  try  to  help  the 
patient  who  is  writing  to  us. 


408  PRACTICAL   ORGANOTHERAPY 

Criticism  Regarding  Advertising.  Personally,  I  do  not 
know  how  to  adhere  more  thoroughly  to  the  fundamental 
principles  of  decency  in  both  professional  work  and  in  busi- 
ness and,  in  spite  of  this,  certain  self -constituted  judges  of 
both  the  advances  in  medicine  and  of  the  ethical  status  of 
the  physician  insist  that  I  am  an  "advertiser" — despite  the 
fact  that  our  advertising  never  reaches  the  laity,  with  our 
consent,  and  that  we  are  only  attempting  to  direct  the  at- 
tention of -'the  profession  to  the  immense  possibilities  in 
the  line  of  work  which  interests  us  so  much,  which  in  many 
thousands  of  instances  are  being  passed  over  by  those 
physicians.  Fortunately  many  hundreds  are  appreciating 
our  efforts. 

It  is  impossible  to  satisfy  everybody  and  the  best  that  I 
can  do  is,  while  adhering  strictly  to  my  own  ideals  of  right, 
to  serve  as  best  I  may  the  majority — those  who  have  an 
open  mind  and  are  willing  to  put  these  ideas  and  the 
products  into  which  they  are  materialized  to  the  only  rea- 
sonable test — "the  test  of  results".  After  all,  Crile  was 
right  when  he  referred  to  "the  crucible  of  the  clinic"  as  the 
only  method  of  testing  the  inherent  value  of  a  remedy. 


5.  BRANCH  OFFICES 


To  facilitate  distribution  of  the  products  of  The  Harrower 
Laboratory  seven  branch  offices  are  maintained  in  different 
parts  of  the  United  States.  With  the  exception  of  the  New 
York  office,  which  is  combined  with  that  of  our  sole  dis- 
tributors for  New  York,  New  England  and  New  Jersey- 
Messrs.  Morgenstern  &  Co. — all  of  these  branches  are  our 
own  branches,  manned  by  our  own  employees. 

Each  office  carries  a  full  supply  of  our  literature  and 
products  and  it  will  be  to  the  advantage  of  the  profession, 
and  the  drug  trade,  to  deal  with  the  nearest  office.  (Letters 
requesing  technical  or  medical  information  necessarily  must 
be  sent  direct  to  the  Home  Office  at  Glendale.)  The  ad- 
dresses are  as  follows :  (In  each  instance  address  The  Har- 
rower Laboratory.) 

New  York  City  31  Park  Place  Barclay  9032 

Chicago,  111.  186  N.  La  Salle  St.  Main  1691 

Baltimore,  Md.  4  East  Redwood  St.  Plaza  3087 

Kansas  City,  Mo.  711-12  K.  C.  Life  Bldg.  Main  2831 

Denver,  Colo.  Central  Savings  Bank  Bldg.          Champa  6190 

Portland,  Ore.  607  Pittock  Blk.  Bdwy.  1640 

Dallas,  Texas  1805  %  Commerce  St.  Y-    '  1894 


SECTION  vin 

INDEX 


Abderhalden'a  Test,   156 

Achlorhydria,    61 

Acidosis,  30.   69,  86,  325 

Acne,  91,  293 

Acromegaly.  44.  80,  123.  125,  126 

Addison's  Disease.  Ill,  173,  220,  347 

Adenoids,    72,   147 

Adenoma,  Thyroid,  96,  97,  98 

Adiposity,  See  Obesity 

Adiposo-Genital  Syndrome.  73,  76,   123 

Adrenal  Apathy,  74 ;  Dyspepsia,  822 ; 
Neuritis,  274 ;  System,  25 

Adrenal  Function,  Tests  for,  158 ;  Treat- 
ment for  Excessive,  255 
Nicholson's  Test,   155 :  Urticaria,  49 

Adrenal  Support,  77,  166 ;  Failures  with, 
S59 ;  Pregnancy,  350 ;  Rationale  of, 
173 ;  Tuberculosis,  167 

Adrenalin,  49,  69 :  Clinical  Test  with, 
160 ;  Goetsch's  Test,  155 ;  Nicholson's 
Test.  155  ;  Urticaria,  49 

Adrenals,  Anaphylaxis,  51 ;  Arsenic.  345  ; 
Asthma,  48  ;  Asthenia,  163  ;  Emotions, 
112 ;  Epilepsy,  238 ;  Everyday  Medi- 
cine, 17 ;  Fear,  112 ;  in  Health  and 
Disease,  111;  Hypertension,  115,  254; 
Hyperthyroidism,  102,  224  ;  Indigestion, 
382 ;  Influence  on  Other  Glands.  33 ; 
Insufficiency  (See  Hypoadrenia)  ;  Irri- 
tability. 69;  Line,  Serpent's  White. 
158;  Malaria.  114;  Neurasthenia,  118; 
Overstimulation  of,  254 ;  Pain,  112 ; 
Physiology.  112;  Rare,  112;  Sensitive- 
ness of  the,  163 ;  Sensitization,  158 ; 
Substance.  56.  63,  69,  77.  304;  Sym- 
pathetic System,  33  ;  Thyroid.  34 ;  Tu- 
berculosis, 114,  174  ;  Worry,  112 

Adrenin.  112 

Adreno-Hypophysis  Co.  (No.  26),  69,  269, 
271.  272 

Adreno-Ovarian  Co.  (No.  79),  77,  198 

Adreno-Spermin  Co.  (No.  1),  53,  74,  75, 
110.  165.  167,  173,  180,  187.  252.  275. 
283.  286.  287,  290,  294,  296.  314,  346, 
350.  354,  358.  360,  362.  363,  370,  373. 
376,  378.  382,  383,  386,  387,  388,  396 

Agalactia,   55 

Albumen,   84 

Albuminuria,  77,  78 

Alcoholic  Intoxication,  85 ;  Thyroid  Dis- 
eases, 99 

Alimentary  Cramps,  64  ;  Hormone,  318  ; 
Neuroses,  184  ;  Toxemia,  57,  68 

Alkaline  Mineral  Reserve,  60,  225 

Alkalinity,   323 

Alkalinization,  Systemic,  85 

Amenorrhea,  42,  56,  76,  77,  101,  123,  192, 
193,  199 ;  Atypical,  Thyroid  Origin, 
347 ;  Hypothyroidism,  94 ;  Pituitary 
Dystrophy,  42 

Amentia,  100 

Amylo-Trypsin  Co.  (No.  12).  61;  Flatu- 
lence, 61 :  Gastric  Dilatation.  61  ; 
Physiological  Effects  of,  61 


409 


Amylopsin,    61 

Anaphylaxis,  51 ;  Adrenals.  51  ;  Endo- 
crines  and.  48,  61  ;  Hyperetnesis 
Gravidarum.  50 ;  Hypoadrenia,  48 ; 
Thymus,  51 ;  Thyroid,  51 

Anemia,  62,  66,  116;  Asthenic,  75;  Chil- 
dren, 72  ;  Hemoglobin,  249  ;  Pernicious, 
62 

Angioneurotic  Edema,   296 

Ankylosis,    92 

Anoci-Association,  82,  113 

Anorexia,   116 

Antagonism,  Hormone,  35 ;  Mammary 
Glands  to  Ovaries,  35 

Antagonistic   Organotherapy,  35 

Anterior  Pituitary.  40,  69,  72.  73,  75, 
76 ;  Substance,  305 ;  Substance,  Bron- 
chial Asthma,  270 

Antero-Pituitary  Co.  (No.  2),  54,  130. 
143,  231.  232.  233.  241,  242.  243,  244. 
245.  247,  348,  352,  353.  367,  370.  381, 
393,  394 

Anti-Hoimone,  Langerhansian,  35 

Apathy,   94  ;  Cellular,  92 

Aphonia,    94 

Appendicitis,   275 

Arthritis,   74,   92,    285 

Asexualism,  75,  76  :  Sterility  in  Women, 
202 

Asiatic  Cholera,  117 

Aspermia,    76 

Association  for  Study  of  Internal  Secre- 
tions, 12 

Asthenia,  53.  69,  74,  76.  77,  95,  114.  116, 
124,  231  ;  Adrenals,  163  ;  Anemia,  75  ; 
Cardio-Circulatory,  93 ;  Commonest 
Symptom  in  Medicine,  161  ;  Frequency 
of,  312  ;  in  Girls,  77  ;  General,  37  ;  Neu- 
ro-Muscular,  54 ;  Severe  following  In- 
fection, 374,  376 

Asthma,  48,  50,  51,  69,  93 ;  Adrenals,  48  ; 
Bronchial,  69,  270 ;  Dyscrinism  Asso- 
ciated with,  48  ;  Endocrine  Aspect  of, 
269  ;  Organotherapy  in,  268  ;  Pituitary, 
48 ;  Thymic,  148  ;  Thymus,  48 ;  Thy- 
joid  Therapy  and,  93 

Athyroidia,   100 

Atrophy,  Genital,  101 ;  Thyroid  Gland, 
99 

Autogenous  Vaccines,   85 

Autonomic  System,  Endocrines  Dominate, 
80 


Babinski  Sign,  127 

Backward   Children,    55 

Bacterial  Vaccines,  51.  85 

Basal  Metabolism  Test,  91 

Basedow's  Disease,  See  Graves'  Disease 

Bed-wetting,   94 

Bile,  24,  25;  Salts,  63,  66.  67.  68;  In- 
sufficiency, 315 

Bile  Salts  Co.  (No.  22),  66,  233,  310,  314. 
317 


410 


PRACTICAL  ORGANOTHERAPY 


Biliary  Insufficiency.  63,  66,  67 ;  Pan- 
creatic Insufficiency,  63 ;  Stimulation, 
314 

Bleeders,    72 

Blood,  Substances  in,  41 ;  Count,  DifTer- 
tial,  40,  160 

Blood-Pressure,  69 ;  Adrenin,  112 :  Go- 
nads,  259  ;  High,  48,  70  ;  Hyperthyroid- 
ism.  264  ;  Low,  33,  54,  77.  165,  256 

Brain  Tumors,  Dyspituitarism.  128 

Bright's  Disease,   See  Nephritis 

Bromides  in   Epilepsy,   236 

Bronchial  Asthma,  69,  270 ;  Anterior 
Pitutiary  in,  270 

Bronchitis,  Chronic,  378 

Cachexia,  57,  62,  63 

Calcium  Phosphorus  Co.  (No.  11),  56, 
58,  66.  74,  75,  226,  227,  276,  284,  329, 
330,  339,  373,  384.  388 

Calorimetry,    155 

Cammidge  Test,   159 

Cancer,  62,  64,  71 ;  Organotherapy  for, 
365  ;  Thyroid,  96 

Carbohydrates,  35 

Cardiac  Asthenia,  64  :  Failure,  64  ;  Weak- 
ness  and  Heart  Hurry,  57 

Cardio-circulatory  Asthenia,  93 ;  Insuf- 
ficiency, 54 

Caries,  91.  326 

Carminative,    61 

Cells,  Selective  Capacity  of,  38 

Cellular  Apathy,  77,  92 ;  Growth.  73 ; 
Infiltration,  90 ;  Intoxication,  161 ; 
Poisoning  in  Thyroid  Insufficiency,  59; 
Rest,  Favoring.  25 ;  Wastes,  84 

Chemistry.   Cell.   59 

Chilblains.  82.  92.  294 

Children.  Anemic,  72 ;  Defective,  Der- 
matoses  in,  229;  Glandular  Therapy 
for,  228 ;  Obesity  in,  335 ;  Subthyroid. 
87  ;  Symptoms  of  Thymus  Hyperplasia 
in,  146;  Syphilis  and  Defective,  371, 
372 

Chilliness,   92,  95 

Chloasma,  294 

Chlorosis,    62 

Cholera,   Asiatic,   117 

Chorea,  55,  68 ;  Organotherapy  in,  393, 
394 

Chromaffin  Tissue,  33 

Circulatory  Skin  Conditions,  293 ;  Stasis, 
33 ;  Climacteric  Disorders,  56 

Clinical  Diagnostic  Therapeutics.  45  ;  En- 
docrine Relations,  32 

Cirrhosis,  67 

Coffee-Drinking,   30 

Cold  Hands  and  Feet,   360 

Colitis,  Mucous,  66 

Collapse,   81 

Colloid  Goitre,  98 

Colloids,  323 

Colon,  Toxemia  Caused  by,  58,  102 

Combinations,  Superior  to  Single  Ex- 
tracts, 36 

Compensatory  Hypertrophy,   33 

Constipation,  63,  66,  92,  95,  100.  116; 
Hypothyroidism  and.  92;  Thyroid 
Treatment  of.  281 

Coordination,   101 

Correlation  of  Glands,   36 

Corpus  Luteum,  27,  66 

Cracking  Joints,   92 


Cretinism,  13,  32,  38,  54.  55.  68,  59, 
80,  83,  101 ;  Deaf-mutism,  101  ;  Epi- 
lepsy and.  236 ;  Infantile,  90 ;  Un- 
founded, 47 ;  Sporadic,  101 ;  Treated 
with  Thyroid  and  Pituitary,  40 

Cryptorchidism,   129,  130 

Crystalloids,  323 

Cutaneous  Infections,  91 

Cyanosis,  92 

Cystic  Goitre,  98 

Dead  Fingers,  92 

Deaf-mutism,  101 

Death,  Thymus,  49 

Defective  Children,  54 ;  Dermatoses  in, 
229  ;  Elimination,  59  ;  Glandular  Ther- 
apy for,  228:  Syphilis  and,  371,  372 

Deficient  Cell  Chemistry,  12  ;  Growth,  55  ; 
Mammary  Development,  377 

Delayed  Menses,  94 

Demineralization,  30,  60,  327 ;  Dyscrin- 
ism  and,  364  ;  Hyperthyroidism,  225 

Dercum's  Disease,  124 

Dermatology,  Endocrines  in,  288 

Dermatoses,  59,  91 ;  in  Defective  Chil- 
dren, 229 ;  of  Ovarian  Origin,  293 ; 
Hypothyroidism,  91 

Development,  Dystrophies,  73 ;  Endocrine 
Control,  80 

Diabetes,    320 ;    Loewi's    Test    for,    159 ; 

Mellitus.  35 ;  Pancreatic,   152 

Diagnostic  Organotherapy,  45  ;  Therapeu- 
tics, Clinical,  45 

Differential  Diagnosis  of  Goitre,  59 ;  Hy- 
perthyroidism, 97 

Dosage,   Endocrine,   391 ;  Step-ladder,    58 

Ductless  Glands,   See  Endocrines 

Duodenal  Extracts,  Reinforcing,  322 ; 
Mucosa,  64 

D-varfism,  55  ;  Myxedematous,  90 

Dyscrinism,  34,  48,  55 ;  Asthma  Asso- 
ciated with,  48  ;  Demineralization  and, 
364 ;  Search  for  in  Neuroses,  185 

Dysfunction,    Influence  of   Endocrine,   30 

Dyshormonism,  99 

Dysmenorrhea,  42,  56,  70,  77.  95,  193. 
199 

Dysovarism,  56,  70,  77 ;  Epilepsy  and, 
49,  239 ;  Organotherapy  in.  46 ;  Pitui- 
tary Factor  in,  199  :  Rheumatism  and, 
284  ;  Thyroid  and,  34  ;  Thyroid  Extract 
in,  39 

Dyspepsia,   Adrenal,   322 

Dyspituitarism.  122  ;  Brain  Tumors,  128  ; 
Syphilis  and,  128 

Dyspnea,  93,  95 

Dysthyroidism,   103 

Dystrophia  Adiposo-genitalis,  75,   76,   123 

Eclampsia.  87  ;  Parathyroids,  150 

Eczema,   91,  289,   291 

Edema.    100 

Ehrlich's  "Side  Chain  Theory,"  41 

Elimination,  Albumen,  77  ;  Defective,  59  ; 
Nitrogen,  84 

Emetin,  85 

Emotions,  Adrenals,  112 ;  Hyperthyroid- 
ism, 102 

Empirical  Organotherapy,  24 

Encephalitis   (Post)    Sequelae,    387,   389 

Endemic  Cretinism,  101 ;  Goitre,  342 

Endocrinasthenia,   164 


INDEX 


411 


Endocrine  Aspect  of  Anaphylaxis,  48. 
51  ;  Asthma,  269 :  Cold  Hands  and  Feet, 
360.  363  ;  Dermatology,  288  ;  Epilepsy. 
47,  49.  239 ;  Growth,  228 ;  Headaches, 
17  ;  Hypertension.  256 ;  Intestinal  Sta- 
sis, 309 ;  Morphin  Addicts,  354 ;  Neu- 
rasthenia, 188 ;  the  Neuroses,  182 ; 
Obesity,  17,  334,  336 ;  Pediatrics,  17  ; 
Pellagra,  370 ;  Sterility,  76 ;  Syphilis, 
87 

Endocrine  Balance,  Importance  of,  265 

Endocrine   Complex,  Treating  an,   306 

Endocrine   Dosage,    Some   Points  on,    391 

Endocrine  Glands,  Hyperfunction  of,  43  : 
Insufficiencies  of,  60  ;  Irritability,  Neu- 
tralizing, 256  ;  Relation  of,  13 

Enuresis,   65,   82,    94 

Epilepsy,  54,  55,  65  ;  Adrenal  Irritability 
in,  238 ;  Basedow's  Disease,  236 ;  Bro- 
mides in,  236 ;  Clinical  Reports  in, 
242  ;  Cretinism,  236  ;  Diagnosis  of  En- 
docrine, 352.  353  ;  Ductless  Glands,  49  ; 
Dysovarism.  49,  239 :  Endocrine  As- 
pects of,  47  ;  Endocrine  Disorder,  17  ; 
Endocrine  Element  in,  239  ;  Endocrine 
Imbalance  in,  49  ;  Endocrine  Stand- 
point, 235 ;  Experience  with,  47  ;  Hy- 
pothyroidism,  236  ;  Idiopathic,  240. 
242  ;  Myxedematous  Idiocy.  236  :  Mys- 
terious Disease,  235  ;  Ovarian.  56,  239  ; 
Pituitary  Insufficiency,  125.  237  ;  Suc- 
cess in  Certain  Cases  of.  240  :  Thyroid 
Factor  in,  236 ;  Thyroid  Insufficiency, 
244 

Epinephrin,  44 

Epiphyses,  Joined,  348 

Erb's   Test,    148,    159 

Erethism,    197 

Erysipelas,   84,   91  :  Hypothyroidiam,  91 

Erythema  Pernio.   294 

Ethical  Status,  Our,  407 

Eunuchoidism,    73,    130 

Exanthemata,  84 

Excipient,   61 

Exophthalmic  Goitre,  43.  97.  102 

Exophthalmos,  103 ;  Hyperthyroidisna 
without,  349 

Extracts,  Administration  of  Glandular, 
25 :  Combinations  Superior  to  Single, 
36 ;  Hormone-bearing,  26 ;  Properly 
Prepared,  23 ;  Reinforcing  Duodenal, 
322 


Failures  with  Adrenal  Support,  359 ; 
with  Organotherapy,  26 

Fatigue,  92  ;  Adrenal,  165  ;  Syndrome,  54, 
77.  312 

Fever,  Rheumatic,   84 ;   Scarlet,   37 

Fibroids,  Uterine,  71 ;  Ovarian  Element 
in,  140 

Flatulence,    61 

Flushing,   Intestinal.   310 

Focal  Infection,  30,  84,  275 

Fright,  102 :  Adrenals  in.  112 ;  Goitre 
and,  102 ;  Mental  Deterioration  follow- 
ing. 367 

Froehlich'a  Syndrome,  73,  128,  198,  204, 
305 

Galactagojme.  55 ;  Formula,  Pluriglandu- 
lar.  218:  Organotherapy,  208;  Pla- 
centa Substance,  209 


Galactorrhea,  Control  of,  211 

Gangrene,   Raynaud's,   y^ 

Gastric  Dilatation,  61  ;  Insufficiency,  61 ; 
Secretion,  64 

Giddiness,   94 

Gigantism,  80  ;  Hyperpitnitarism,  126 

Girls,  Thyroid  Enlargement  in,  358 

Glands,   Correlation  of,    36 

Glucose,  44  :  Test,   157 

Glycosuria  Test,   Marie's,   157 

Goetsch's  Adrenalin  Test,  154,  155,  220 

Goitre,  60,  65,  87,  96  ;  Colloid,  98  ;  Cystic, 
98 ;  Differential  Diagnosis,  59 ;  En- 
demic, 342  ;  Exophthalmic,  43  ;  97.  102  ; 
in  Girls,  38 ;  in  the  Male,  344 ;  Men- 
struation and,  38  :  Parenchymatous,  98  : 
Simple,  98 ;  Simple.  Suggestions  in. 
340 ;  Simple,  Supplementary  Organo- 
therapy. 344  ;  Toxic,  58 

Gonad  Asthenia,  72 ;  Dysfunction.  299 ; 
Function,  32,  73 ;  Function  Disturbed, 
85  ;  Neuroses,  183 

Gonad  Co.  (No.  70),  75,  205.  299,  303. 
307,  308,  391 

Gonad-Ovarian  Co.  (No.  73),  76,  137. 
196,  205,  207,  338 

Gonad-Pituitary  Relation,  200 

Gonads.  Blood-Pressure,  259  ;  Endocrines. 
Other,  304  ;  Male,  Endocrine  Dysfunc- 
tion of.  128  :  Thyroid  and.  32.  34,  85 

Graves'  Disease,   43.   64,   65,   102.   147.  236 

Growth.  83 ;  Defective,  in  Children.  17 : 
Deficient,  55 ;  Endocrine  Control  of, 
80.  228  ;  Stimulation,  Remarkable,  233 ; 
Stunted,  348 

Hair.  Thyroid  and,  91,  100,  295 

Hallion's   Law,   24,   39 

Hay  Fever,  271 

Harrower's  Hypothesis,  41  :  Criticisms  of, 

43  ;  Thyroid   Function  Test.    156  ;  Thy- 
roid Test,  Advantage,   274 
Headache,     94,     95 :    in    Hypothyroidism, 

94  ;   Premenstrual,    32  ;  Pituitary.    231 ; 

Post-climacteric,   136 
Heart,  See  Cardiac 
Heat  Regulation,  84 
Hemadenology,  82 
Hematopoiesis,   62,   84 
Hemoglobin,   62  ;  Repurified,  75  ;  Routine 

Value  of.  250 

Hemoglobin  Co.   (No.  13),  62,  252,  349 
Hemophilia,   72 
Hemorrhage,     64,     65.     71,     72 :     Intra- 

adrenal.  113 
Hepatic    Disease.    67  ;     Parenchyma,    57 ; 

Substance,   67  ;  Stimulant.   67  ;  Torpor, 

68 

Hepato-alimentary  Insufficiency.  63 
Hepato-biliary  Insufficiency,  24.  57 
Hepato-Splenic  Co.  (No.  5).  57.  175,  313. 

314,   374 

Horpes,  91  :  Urticaria  and.  295 
Hertoghe's  Bladder  Desquamation  Theory. 

246  ;  Disease,   109 
Hoarseness,  94 
Homostimulation,   36 
Homostimulative  Organotherapy.   74 
Hormone    Antagonism,     35 ;    Hunger,    a 

Hypothesis    of,    36 ;    Mammae.    Control 

of,  208,  212;  Satiety.  41,  45;  Starling's 

Alimentary,  318;  Stimuli,  36;  Therapy, 

20,    28,   82 


412 


PRACTICAL  ORGANOTHERAPY 


Hormones  in  Blood  Stream,  39 ;  Faculty 
of,  23 ;  Influence  of,  79 ;  Selecting  the, 
from  Blood,  37  ;  Status  of,  22 

Hydrophobia,   51 

Hyperacidity,  60 

Hyperadrenia,  33,  34,  44,  113 

Hypercrinism,  34,  45 

Hyperemesis  Gravidarum,  74 ;  an  Ana- 
phylaxis,  50  ;  Placenta  Therapy  in,  50 

Hypernephroma,   115 

Hyperovariam,  197 

Hyperparathyroidism,   151 

Hyperpituitarism,  125  ;  Acromesralia,  125  ; 
Differentiating  Lobes  Involved,  127 ; 
Gigantism.  126 ;  Neighborhood  Symp- 
toms in,  126 ;  Strabismus,  127 

Hypertension,  17,  48 ;  Adrenal  Glands 
and,  115,  ?54 ;  Endocrine  Side  of.  256 ; 
Exophthalmic  Goitre,  97 ;  Functional. 
69 :  Hypothy  roidism.  Infiltration  and, 
263 ;  Menopausal,  387,  389.  390 ;  Ova- 
rian Dysfunction  a  Cause  of,  259  ;  Pan- 
creas Gland,  a  Remedy  for,  258 

Hyperthymism,  144 

Hyperthyroidism,  34,  35.  44,  45,  57,  72, 
96,  178;  Adrenals,  102.  224;  Alkaline 
Reserve,  225 ;  Antagonistic  Organo- 
therapy in,  222  ;  Associated  Treatment 
of,  224 ;  Blood-Pressure  in,  264 ;  De- 
mineralization  in,  225 ;  Differential 
Diagnosis  of,  97  ;  Disturbances  in  Other 
Glands.  220 ;  Emotions  and,  102 ;  Es- 
sential Etiology  of,  218 ;  without  Ex- 
ophthalmos,  349 ;  Failures  in  Treat- 
ment, 221 ;  Fright  and,  102 ;  Metabol- 
ism. 97.  103 ;  Ovaries,  221  ;  Pancreas 
Gland.  224  ;  Pluriglandular  Therapy  of, 
266  ;  Pulse  in,  108 ;  Skin  in,  104 :  Sym- 
pathetic Irritability,  104 ;  Sympa- 
theticotonus  in,  373  ;  Symptoms  of,  104  ; 
Tachycardia,  103  ;  Tests  for.  154  ;  Thy- 
mus  Gland,  220  ;  Toxemia,  102  ;  Treat- 
ment in,  218,  219  ;  Tuberculosis,  178 

Hypertrophied  Prostate,  73 ;  Tonsils, 
Children  with,  72 

Hypertrophy,  Compensatory,  33 

Hypoadrenia,  33,  49.  51.  54,  69,  75,  77. 
100.  115,  162;  Anaphylaxis  and,  48; 
Fatigue  and,  162 ;  Functional,  116 ; 
Functional,  Sergent's  Test,  346 ;  Pro- 
gressive, 117  ;  Symptoms  of,  116,  165  ; 
Symptoms  of  Terminal,  118 ;  Terminal, 
117 

Hypoalkalinity,  30 

Hypochlorhydria,  63 

Hypocrinism,  33,  86 

Hypogalactia,   55 

Hypogonadism,  71,  72,  73,  75,  76,  129, 
300 

Hypo-Ovarism,  76,  198 

Hypoparathy roidism,  68,  150 

Hypopituitarism.  55,  72,  75.  76,  122,  206  ; 
Epilepsy.  125.  237;  Obesity,  124; 
Syphilis,  124 

Hypoprostatism  and  Neurasthenia,   297 

Hyposphyxia,  116,  171 

Hypotension,  53,   116 

Hypothesis,  Harrower's,  Criticism  of,  43  ; 
of  Hormone  Hunger,  41 

Hypothermia,  95 

Hypothymism,  143 

Hypothyroid  Insufficiencies,   101 


Hypothyroidism,  13,  25,  30,  32,  33,  38, 
39,  55.  58,  65,  66.  85.  86,  87,  88,  90,  92, 
95,  98,  99,  100,  178,  191,  203,  327  ; 
Acidosis  in,  59  ;  Amenorrhea,  94  ;  Bed- 
wetting  in,  94 ;  Bladder  Symptoms  in, 
93 ;  Cellular  Infiltration,  263  ;  Cellular 
Poisoning  in,  59 ;  Clinical  Findings  in, 
90  ;  Constipation,  92  ;  Dermatoses,  91 ; 
Erysipelas,  91 ;  Epilepsy,  236,  244 ; 
Frequency  of,  88 ;  Headache  in,  94 ; 
Infiltration,  Chief  Symptom  of,  89 ;  In- 
filtration and  Hypertension,  263  ;  Men- 
orrhagia,  95 ;  Mental  Slowness  in,  94  ; 
Obesity,  Common  Feature  of,  86 ;  Ob- 
stipation, 93 ;  a  Pluriglandular  Disor- 
der, 32 ;  Rheumatism  and.  281  ;  Skin 
and,  91  ;  Stasis  and,  92 ;  Teeth  and,  91 ; 
Toxemia.  84 ;  Tuberculosis  and,  177 

Hysteria,  81,  119 

Ichthyosis.    289:    in    a    Boy.    392.    393; 

Scleroderma  and.  299 
Idiopathic  Epilepsy,  240,  242 
Immunity,    Pancreas    and,    153;    Theory 

of,  41 

Impotence,    17,    71,    75.    101,     123;    En- 
docrine,  76;  Prostatic  Form  of,   298 
Inanition,  Thyroid,   93 
Indigestion,      61,      63 ;       Adrenal,      382 ; 

Chronic,  63 ;  Intestinal,   67,   68 
Infantilism,    54,    72,    76 ;   Essential.    129 ; 

Organic  Ovarian,   195 
Infections,  Cutaneous.  91 ;  Focal.  84 
Infectious  Diseases,   87 
Infiltration.  Cellular.  90 
Influenza,  37.   84 
Insanity.  138,  197 
Insomnia,   313 
Intestinal  Flushing.  310 ;  Indigestion,  66, 

68  ;  Intoxication,    63,    85  ;   Paresis,    64  ; 

Stasis.  31.  57,  309.  312,  327 
Intoxication.  Alcoholic,  85 ;  Cellular,  161 ; 

Drug,  85 ;  Intestinal,  85 
Iodized   Thyroid    Co.    (No.    18),    65,    343. 

344,  390,  391 
Islets  of  Langerhans,  35 

Kinetic  System,  82,  113 

Lactation,  Prolonged,  87 

Langerhans,  Islets  of,  35,   256 

Lecithin,  62.   63.    382 

Leucocyte  Production,  62 

Leydig  Cell  Co.   (No.  41),  71.  297,   357 

Leydig    Cells    in    Hypogonadism,    71  ;    in 

Impotence,  71  ;  Physiological  Effects  of, 

71 ;  in  Prostatic  Hypertrophy.  71 
Libido,    Influence   of   Organotherapy    on, 

206;  Lack  of,  76 
Liquor  Hypophysis   (No.   16),   24.   64,   72, 

222.   247,    314,    337 
Liver,    35.   57 
Locomotor   Ataxia,    29 
Loewi's  Test.   154,   159 
Lymphatic  Co.   (No.  43),  72 
Lymphatic  Glands,   73 
Lymphatism,  72 

Malaria.  92.  118 ;  Adrenals  and,  114 
Malnutrition.    57,    62,     66,    72.    75,     87; 

Dermal,    91 ;   Thyroid    Instability    and, 

87 


INDEX 


413 


Mammae,    Atrophy   of,    S3;    Antagonism 

of    to    Ovaries,    35 ;   Hormone    Control 

of.    208 
Mamma-Ovary    Co.    (No.    38).    70,    186, 

197,   215,    376,   377 
Mamma-Pituitary   Co.   (No.  40).   71.   140, 

186,  197,  215.  216,  355,  384 
Mammary  Development,  33,  377  :  Extract, 

27.    55,    70,    71,    215 :    Products,    Men- 

orrhagia,  217  ;  Stimulaut,  55  ;  Therapy, 

35 

Marasmus,   62,  63 
Measles,  37 
Melancholia,  54 
Memory,  Loss  of,  95 
Menopausal    Adiposity,    335 :    Difficulties, 

136,    194 ;   Hypertension,    387,   389.   390 
Menopause.   34,   42,   56 ;   Rheumatism  in, 

284 
Menorrhagia,    35,    70,    71,    94,    101.    136, 

216  ;  Control  of,   213 ;  Hypothyroidism, 

95  ;  Therapy  in,  217,  356  ;  Thyroid,  101 
Menses,    Difficulties.    42,    46,    95 ;    Early 

Postpartum,    384 ;    Function    and   Thy- 
roid, 32;  Prolonged,  70.  95 
Menstruation,    56,    84 ;   Dysovarism    and, 

132 :  Goitre  and,   38 ;  Thyroid  and,   95 
Mental      Backwardness,      59 ;      Following 

Fright,  367  ;  in  Hypothyroidism,  94 
Mentality,     Defective,    in    Children,     17 : 

Myxedema  and,   100  ;  Retarded,  65 
Metabolic  Dyscrasias,  59,  60.  101 
Metabolimetry,    155 
Metabolism,    32.    59,    66,    74,    83;    Basal 

Test,    91 ;    Carbohydrate,    73 ;   Ductless 

Glands  and.   80,   287;  Faulty,   12,   116; 

Hyperthyroidism,    97,    103 ;    Liver,    94 ; 

Protein.   51 ;  Thyroid  and,   84,   85,    262 
Meteorism,  64 
Metrorrhagia,   71 
Micturition,  72 
Migraine,  94 
Mongolian,  55,  59 
Morphin,  69,  74  ;  Addicts,  Endocrines  in, 

352  ;  Poisoning  with,  31 
Mucinase,   315 
Mucous  Colitis,  66,  67,  316 ;  Relation  of 

Secretin  to,  317 
Multiple  Sclerosis,  29 
Muscular   Atonicity.    33 ;  Efficiency,    84 
Myasthenia,  104 
Mydriasis  Test,  154 
Myxedema.    32.    38,    $8,    *»,   91,    99,    100, 

134,  288 ;    Functional    Ovarian    Disor- 
ders in,  38  ;  Hair,  10»  ;  Infantile,   101 ; 
Mentality   and.    100;   Nails.    100;  Neu- 
ritis and.  273  ;  Skin,  10»  ;  Teeth,  100 

Myxedematous  Dwarnsa,  90 ;  Epilepsy 
and  Idiocy.  236 

Nausea,  51 ;  of  Pregnancy,  73,  74  ;  Pro- 
tein Sensitization,  351 

Nephritis,  77.  78,  333;  Clinical  Tests, 
331  ;  Pluriglandular  Renal  Therapy, 
330.  333 

Nervous  Irritability,  103  ;  States,  46  ;  Sys- 
tem, Endocrines  Dominate,  80 

Neuralgia,  94,  95  ;  in  Hypothyroidism,  94 

Neurasthenia,    53,    54,    56,    82,    87,    118, 

135,  181,  327;  Adrenal  Syndrome,  118; 
Endocrine    Syndrome,    17,    188 ;   Hypo- 
prostatism,    73,    297 ;    Ovarian    Insuf- 
ficiency. 135 ;  Sexual,  76 


Neuritis  and  Appendicitis,  275 ;  Organ- 
otherapy in,  273;  Thyro-Adrenal  In- 
sufficiency, 275 

Neuroses,  42,  54,  56,  81 ;  Alimentary,  184 ; 
Endocrine  Aspect  of  the,  182 ;  of 
Gonad  Origin,  183 ;  Pluriglandular 
Therapy  in  Functional,  180 ;  Psychoses 
and  Insanity.  195 ;  Search  for  Dys- 
crinism  in,  185 

Nicholson's  Adrenalin  Test,  155 

Nitrogen  Elimination,   84 

Nocturnal  Enuresis,  82,  245 ;  Bladder 
Desquamation  Theory,  246 ;  Posterior 
Pituitary  in,  247  ;  Thyroid  in.  247 

Nuclein,   62,   65,  73 

Nucleo-Lecithin  Co.  (No.  14),  62 ;  in 
Marasmus,  62 ;  in  Rickets,  62 

Nutrition,  Deficient  in  a  Child,  17,  381 ; 
Disorders  of.  59 ;  Seeretin,  320 ;  Skin. 
84 

Nymphomania,  197 

Obesity,  59,  60.  86,  92 ;  in  Children,  335 ; 
Endocrine  Aspects  of,  334,  336 ;  Pit- 
uitary Factor,  124,  336 ;  Remineraliza- 
tion,  339  ;  Thyroid.  86.  101.  336 ;  Treat- 
ment of,  338,  339 ;  in  Women,  334 

Oculocardiac  Reflex,  158 

Oligocholia,   315 

Organotherapy,  Antagonistic,  35  ;  Aithma, 
268 ;  Cancer,  365 ;  Chorea,  393,  394 ; 
Diagnostic,  45,  47 ;  Dysovarism,  46 ; 
Empirical,  24  ;  Failures  with,  26 ;  Gal- 
actagogue,  208  ;  Homostimulative,  24  ; 
Hyperthyroidism,  222  ;  Influence  of  on 
Libido,  206 ;  Interest  in,  19 ;  Litera- 
ture on,  22 ;  Neuritis,  273 ;  Prostatic 
Disorders,  296.  299;  Specific,  24;  Sub- 
stitutive,  £3 ;  Supplementary,  in  Simpla 
Goitre,  344  ;  Synergistic,  84 

Osteomalacia,   139 

Ovarian  Changes,  66 

Ovarian  Disorders,  24,  46,  69  ;  Diagnosis 
of,  132  ;  Epilepsy,  56,  239 ;  Functional, 
38,  77.  190  ;  Neurasthenia  in,  135  ;  Or- 
ganic, 140  ;  Treatment  of,  199 

Ovarian  Endocrine  Function,  70,  71 

Ovarian  Excess,  Causes  of.  139 

Ovarian  Extract,   25 

Ovarian  Irritability,  35,  158,  197,  198 ; 
and  Adrenal  Depletion,  158 

Ovarian  Substance,  56,  57,  69,  7» 

Ovarian  Therapy,   193,   366 

Ovarian-Thyroid  Relation,  38 

Ovaries,  Antagonism  of  Mammae,  35 ; 
Hyperthyroidism,  221  ;  Oversecretion  of, 
138 ;  Rheumatism,  284  ;  Thyroid.  32,  42, 
94 

Oxidation,  Deficient,  91 


Pain  and  the  Adrenals,  112 

Pancreas  Co.  (No.  6),  57,  179,  223,  226. 
227.  265,  346,  373,  386,  387,  406 

Pancreas,   Endocrine  Dysfunction,   151 

Pancreas  Gland,  57.  69.  77,  178;  Hyper- 
thyroidism and,  224 ;  Hypertension, 
258:  Immunity  and,  153 

Pancreas,    Insufficiency,    Tests   for,    159 ; 

Pancreas,  Physiology,   77 

Pancreas,   Secretion,  63 

Pancreatic  Diabetes,  152 ;  Loewi's  Test 
for,  159 


414 


PRACTICAL  ORGANOTHERAPY 


Pancreatin.  61,  68 

Pancreatin-Bile  Co.  (No.  23),  67 ;  In- 
testinal Indigestion,  67 

Paralysis,  29.  191 

Paralysis  Agitans,  68,  150,  384 

Parathyroid  Co.  (No.  24),  68.  384,  394 ; 
Hypoparathyroidism,  68 :  Physiological 
Effects  of,  68  ;  Tetany,  68 

Parathyroid  Dysfunction,  Tests  for,  159  ; 
Glands.  Desiccated.  35,  68 

Parathyroids,  Disturbances  of  the,  148 : 
Eclampsia,  150 ;  Influence  of,  68 ;  In- 
sufficiency, 68,  148 ;  in  Paralysis  Agi- 
tans, 24 

Parenchymatous  Goitre,  98 

Parkinson's  Disease,  68,  150,  384 

Pellagra,  Endocrine  Aspect  of,  370 

Pelvic  Toxemia,  58 

Pernicious  Anemia,  62 

Persistent  Thymus,  58 ;  Ovarian  Disor- 
ders and,  196 

Petit  Mai,  55  (See  Epilepsy) 

Phimosis.  245 

Phosphorus,    63_ 

Pigmentary  Skin  Conditions,  294 

Pineal  Gland.   35 

Pituitary  Affections,  Cause  of,  128 ;  An- 
tagonist to,  264 

Pituitary,  Anterior,  75 

Pituitary  Body,  64,  120 ;  Epilepsy  and, 
127  ;  Sex  Development,  121 ;  Total  Sub- 
stance. 55,  56 

Pituitary  Co.   (No.  47).  72,  344 

Pituitary  Dysfunction,  73 :  Dysfunction, 
Tests  for,  157 :  Dysovarism,197 :  Dys- 
trophy and  Amenorrhea,  42 ;  Enlarge- 
ment of.  34 

Pituitary  Gland.  39,  57,  71 ;  Epilepsy  and, 
125,  237  :  Extract  of.  21 ;  Involvement 
Of  the,  237;  Total.  72 

Pituitary  Gonad  Relation,  200 ;  Head- 
aches, 32,  201 ;  Influence,  41 ;  Metabol- 
ism and,  32 ;  in  Nocturnal  Enuresis, 
247 ;  Relation  of.  to  Sex  Glands,  32 ; 
Sterility,  204 

Pityriasis,   289 

Placenta  Co.  (No.  49).  73,  334,  350,  351, 
378,  379,  380 

Placenta,  Desiccated,  55,  73 ;  Galacta- 
gqgue.  209 :  Hyperemesis  Gravidarum, 
50 ;  Pituitary  Antagonist,  264 ;  Sub- 
stance, 50.  51 

Placenta!   Proteids,   50;  Toxemia,   73,   74 

Placento-Mammary  Co.  (No.  3),  55,  211, 
215,  376.  379,  384,  385,  386 

Pluriglandular  Disorder,  31 ;  Dosage,  44  ; 
Formulas,  14,  53.  286 ;  Galactagogue 
Formula,  210 ;  Idea,  16,  28 ;  Ovarian 
Therapy,  193;  Theory,  31 

Pluriglandular  Therapy,  Explanation  of, 
40 ;  Discrepancies  in,  368,  369 ;  Func- 
tional Neuroses,  180  ;  Hyperthyroidism, 
266 

Pneumonia,  31 

Poisoning,  by  Alcohol,  31 ;  Cellular,  in 
Thyroid  Insufficiency,  59 ;  Protein,  48 

Post-abortion  Infection,  49 

Postpartum  Menses.  Early,  384 ;  Regu- 
lator. 55  ;  Stimulant,  55 

Precocity.  125 

Pregnancy,  64,  85 ;  Adrenal  Support 
During.  350 ;  Nausea  of,  73,  74,  381 : 
Toxemia,  50,  87  ;  Vomiting  of,  50,  73, 
80,  379 


Premature  Senility,  76,  131,  144 

Premenstrual  Headache,  32 

Progeria,    131.   144 

Prostate  Co.  (No.  48),  73.  187,  298 

Prostate  Gland  Extract,   73,  75 

Prostate,  Hypertrophied,  34,  73,  297, 
357  ;  Impotence  in,  298  ;  Neurasthenia 
in,  73 ;  Organotherapy  in,  296 

Prostato-Gonad  Function,  76 

Protein  Metabolism,  51  ;  Poisoning,  48 ; 
Sensitization,  48,  51 ;  Sensitization, 
Nausea  of  Pregnancy.  351  ;  Toxins,  48 

Psoriasis,   91.   289 ;  Rheumatism,   280 

Psychasthenia,  54 

Psychoses,  56 ;  and  Insanity,  195 

Queries  and  Answers,  Endocrine,  345 
Quinin  in  Malaria,  118 

Raynaud's  Disease,  92,  294 

Remineralization,  59,  60,  85,  225,  235 ; 
Endocrine  Obesity,  339  ;  Formula.  329  ; 
Influence  on  the  Endocrines,  327  ;  Or- 
ganotherapy in  Neuritis,  276 ;  Practical 
Therapeutic  Application,  328 

Renal  Activity,  Deficient,  78 

Renal  Co.   (No.  85),  77,  333 

Renal  Efficacy,  77 ;  Glomerular  Tissue. 
77 ;  Impermeability,  77,  331 ;  Therapy 
in  Nephritis,  330.  333 

Respiratory  Quotient,  156 

Rickets,  62,   63 

Rheumatic  Fever,  84 

Rheumatism,  60,  92,  95,  277,  327 ; 
Acidosis  in,  284 ;  Alimentary  Factor, 
278 ;  Chronic,  74 ;  Dysovarism,  284  ; 
Hypothyroidism,  281  ;  Menopause,  284  ; 
Psoriasis,  280;  Routine  in,  283;  Thy- 
roid Therapy,  281 ;  Run-down  Condi- 
tions, 53 

Salts,  Mineral  in  Health  and  Disease. 
S23 

Sanitablet,  404,  406 

Scleroderma,  289,  291 ;  Ichthyosis,  290 

Sclerosis  of  Thyroid,  99 

Secretin  Co.  (No.  15),  63,  279,  295,  314, 
317.  318,  322,  323,  382,  383,  384;  Indi- 
gestion, 63 ;  Intestinal  Stasis,  63 ; 
Physiological  Effects  of.  63 

Secretin.  Effects  of,  314 ;  Influence  of, 
on  Nutrition,  320  ;  Mucous  Colitis,  317  ; 
Origin  of,  318;  Value  of,  319 

Senility,  71,  73,  76  ;  Hypogpnadism,  132  ; 
Premature,  144  ;  Presenility,  131 

Sensitiveness,   Organotherapeutic,    50 

Sergent's  White  Line,   346 

Serum  Sickness,  49 

Sex  Complex,  76 ;  Development,  121  ; 
Glands,  Pituitary.  32  ;  Glands,  Thyroid, 
85  ;  Hormones,  85 

Sexual  Apathy,  56 ;  Disturbances,  Func- 
tional. 131 ;  Insanity,  138 ;  Neuras- 
thenia, 76 

Shock,   64.   65.  81 

Simple  Goitre,  59.  66,  98,  340,  344 

Sinuses.  Toxemia  due  to,  58,  102 

Skin  Disorders,  95,  293,  294 ;  Hyperthy- 
roidism, 104  ;  Hypothyroidism,  91  ;  Myx- 
edema,  100 ;  Thyroid,  100 

Spermin,  Dynamogenic  Effect,  301  ;  Ex- 
tract. 53,  57.  68.  69.  71,  73,  75,  76 

Spermin-Hemoglobin  Co.  (No.  68),  75. 
346 


INDEX 


415 


Spleen  Parenchyma,  67.  62,  72 

Sporadic  Cretinism.   101 

Stammering,   Thymus,   143 

Stasis.  63,  64,  68,  86,  92 ;  Hypothyroid- 
ism,  92 

Status  Lymphaticus,  49 :  Thymo-lympha- 
ticus.  147 

Sterility,  17 ;  Endocrine,  76 ;  Func- 
tional. 136 :  Pituitary  Basis.  204 ; 
Women.  202 

Stiff  Neck.  82,  92 

Stimulant.  64  ;  Hepato-biliary,  67  ;  Mam- 
mary, 55  ;  Post-partum,  55 

Strabismus,   Pituitary,   127 

Stunted   Growth,    348 

Subinvolution,  Uterine,  71 

Suboxidation,    59 

Sugar     Mechanism,      35 ;     Mobilization, 
Control  of,   152  ;  Tolerance  Estimation, 
157 

Sweat  Glands,  100 

Sympathetic  Irritability.  34,  57,  104 

Sympathetic  System.  33 ;  Controlled  by 
Adrenals,  33  ;  Endocrines  Dominate,  80 

Sympatheticotonus,  35,  50.  103 ;  in  Hy- 
perthyroidism.  373  ;  Tuberculosis.  386  ; 
Vagotonus,  181 

Syncope,  93 

Syphilis,  84,  87,  88 ;  Defective  Children. 
371 ;  372 :  Dyspituitarism,  128 ;  En- 
docrine Disorder,  87  ;  Hypopituitarism, 
124 ;  Thyroid  Diseases,  99 

Tabes.  64 

Tachycardia,    103 

Teeth,  Hypothyroidism,  and,  91 ;  Myxe- 
dema,  100  ;  Toxemia  Caused  by,  58 

Temperature,    100 ;    Subnormal,    396,    397 

Test.  Abderhalden's,  156 ;  Adrenalin,  160  ; 
Basal  Metabolism,  91 ;  Cammidge,  159  ; 
Chronic  Disease,  110 ;  Galactose,  157  ; 
Glucose,  157 ;  Goetsch's  Adrenalin, 
155  ;  Harrower's  Thyroid  Function,  40. 
45,  105,  107,  156,  341  ;  Levulose.  157 ; 
Loewi's  Mydriasis,  154  ;  Loewi's  Pan- 
creatic Diabetes,  159 :  Marie's  Glyco- 
suria,  157  :  Nicholson's  Adrenalin,  155  ; 
Sucrose,  157 ;  Thyroid,  59 ;  Wasser- 
mann,  88 

Testes,  Influence  of  Thyroid  upon,  32 : 
Hypertrophy  of,  34 ;  Undescended.  130 

Tetany,  68  ;  Chronic,  150  ;  Symptomatol- 
ogy of,  149 

Thymic  Asthma,  148 

Thymc-Lymphaticus,  Symptoms  of  Status, 
147 

Thymotoxemia,  145 

Thymus,  160 ;  Anaphylaxis,  51  :  Arthri- 
tis Deformans,  285 :  Asthma,  48 ; 
Cases,  Diagnostic  Points  in,  145 ; 
Death.  49 ;  Diseases  of  the,  141 ;  an 
Endocrine  Organ.  49 ;  Extract,  74 ; 
Hyperthyroidism,  220  ;  Hyperplasia  in 
Children,  146  ;  Insufficiency,  143 ;  Per- 
sistent, Ovarian  Disorders,  58,  196 : 
Physiological  Considerations  of  the,  142 

Thymus-Spennin  Co.  (No.  57).  74,  286, 
287 

Thyroid.  27,  56,  57,  65.  69,  70.  71,  72; 
Adrenal  Glands,  34 ;  Alcoholism.  99 ; 
Amenorrhea,  101 ;  Anaphylaxis,  51 ; 
Apathy,  46.  60 ;  Aplasia,  100  ; 
Atrophy.  99  :  Carcinoma,  Sarcoma.  96  ; 
Detoxicating  Influence  of  the,  262 ;  En- 


largement of,  S3,  341 ;  Epilepsy.  236 ; 
Extract,  14.  53.  59,  62.  74.  75,  264; 
Function  Test.  Harrower's,  40,  45.  66, 
105,  107,  156,  341 ;  Girls,  358  ;  Gonads, 
32.  85 ;  Growth.  84 ;  Hair,  91  ;  Hor- 
mone, 43,  66 ;  Immunity,  84 ;  Impo- 
tence, 101  ;  Inadequacy,  91  ;  Inanition, 
93 :  Infiltration,  93 ;  Influence  on 
Ovaries,  94 ;  Influence  on  Testes,  32 ; 
Intestinal  Stasis,  312 ;  Involvement  in 
Neuritis,  273  ;  Liver,  94  ;  Dermatology, 
289  ;  Medication,  85  ;  Menorrhagia,  101 ; 
Menstruation.  95 ;  Metabolism,  84,  85, 
262 ;  Nocturnal  Enuresis,  245.  247 ; 
Obesity,  86.  101,  336 ;  Ovaries.  32.  38, 
42,  86,  192 ;  Pituitary,  Cretin  Treated 
with,  40  ;  Proteids,  85,  Protein  Poison- 
ing, 48 ;  Sclerosis  of.  99 ;  Secretion, 
Estimation  of,  59 ;  Sensitiveness,  46 ; 
Sex  Glands,  85  ;  Skin.  100  ;  Teeth,  91  ; 
Tonsils,  99,  390 ;  Tuberculosis.  99 

Thyroid  Disorders.  13,  32.  85,  94 ;  Dis- 
covery of  Latent,  109  ;  Dysovarisna,  34, 
39  :  Early  Causes  of,  87  ;  Minor,  84 

Thyroid  Instability  and  Malnutrition,  87  ; 
Predisposing  Cause  of,  86 ;  Prolonged 
Lactation,  87  ;  Tuberculosis,  87 

Thyroid  Irritability,  See  Hyperthyroid- 
ism 

Thyroid  Therapy  and  Asthma,  93  ;  Rheu- 
matism, 281  ;  Philosophy  of,  282 ; 
Treatment  of  Constipation,  281 

Thyroiditis,  99 

Thyroids,  Sheep's,   25 

Thyro-Ovarian  Co.  (No.  4).  56,  76,  77, 
137.  186,  193,  194.  195.  196.  199,  200, 
202,  204,  240.  285,  293.  295.  338,  344, 
348,  358.  405 ;  Routine  Administration 
of.  194 

Thyro-Ovarian  Therapy,  95  ;  Reinforcing, 
205 

Thyro-Pancreas  Co.  with  Ovary  (No.  29). 
69,  262.  268,  363.  389.  390 

Thyro-Pancreas  Co.  with  Spermin  (No. 
30).  69,  266,  268,  360,  361 ;  Functional 
Hypertension,  69 

Thyrotoxicosis,   98:  Adenomata.   9! 

Thyroxin.    44,    96,    98 

Tissues,  Selective  Action  of,  43 

Tonsils,    Ameba    in,    85 ;    Enlarged,    147 ; 
Hypertrophied,      Children      with. 
Thyroid,   99,   390,   391  ;  Thyroiditis,   99  ; 
Toxemia  Caused  by,  58.  102 

Toxemia.  31.  58.  63.  86,  92,  100,  102; 
Alimentary,  68;  Colon.  58,  103;  Gall- 
Bladder,  58 ;  Hyperthyroidism,  102 ; 
Nasal  Fossae.  102:  Pelvis,  58:  Preg- 
nancy, 50,  87  ;  Sinuses,  58,  102  ;  Teeth, 
58  ;  Thyroid  Insufficiency,  84  ;  Tonsils, 
58,  102 

Toxic  Goitre,  58 

Tuberculosis,  57,  84.  87.  99.  110.  173, 
327  ;  Adrenals.  110.  114,  167,  174  ;  Hy- 
perthyroidism, 178 :  Hypothyroidism, 
178 :  Latent.  395,  396  ;  Sympathetico- 
tonus in.  386 ;  Thyroid  Factor,  87.  99, 
175  :  Toxic  Element  in,  172 

Tumors,   Brain,   128 

Typhoid  Fever.  31,  84 

Umbilical  Hernia.   101 
Undescended  Testicle,   130 
Uniglandular     Endocrine    Disorder.     31 ; 
Preparations,  34 


416  PRACTICAL  ORGANOTHERAPY 

Urea,  40  Vicious  Circle,   a  Toxic,   162 

Urinary  Excretion,  84  ;  Solids.  40  Vitalait,   381 

Urination,  Frequent,  94  Vomiting,  51,  93;  of  Pregnancy,  60,  51, 

Urticaria,    49,     51,    91;    Adrenalin,    49;  73,  74,   379,   380 

Herpes,   295 

Uterine     Fibroids,    71;    Involutant,     55;  Wastes,   Acid,   59,   60 

Muscular  Tonic,   71 ;   Subinvolution,   71  Wassermann   Test,   88 

Worry  and  the  Adrenals,  112 
Vagotonus,  181 

Vaaoiaotor   Spasm,   92  Xeroderma,  289,  291 


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